Mahvi David A, Pak Linda M, Bose Sourav K, Urman Richard D, Gold Jason S, Whang Edward E
Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
World J Surg. 2019 May;43(5):1332-1341. doi: 10.1007/s00268-019-04916-0.
Pancreaticoduodenectomy is a complex surgery frequently associated with prolonged hospitalizations. However, there are a subset of patients discharged within 5 days from surgery; the preoperative and intraoperative characteristics of this subset are unknown.
The NSQIP Targeted Pancreatectomy Dataset was used from 2014 to 2016. Patients who died within 30 days were excluded. A total of 10,741 patients undergoing pancreaticoduodenectomy were identified. Univariable and multivariable logistic regression analyses were performed for preoperative and intraoperative ACS-NSQIP variables to identify predictors of early discharge. Early discharge was defined as discharge 3-5 days after surgery.
A total of 1105 patients (10.3%) were discharged within 5 days following pancreaticoduodenectomy. On multivariable analysis, preoperative factors associated with early discharge included younger age (OR 0.988, p < 0.001), non-obesity (OR 0.737, p = 0.001), those receiving neoadjuvant chemotherapy (OR 1.424, p < 0.001), and lack of COPD (OR 0.489, p = 0.005) or hypertension (OR 0.805, p = 0.007). Intraoperative factors associated with early discharge on multivariable analysis were shorter operation duration (OR 0.999, p = 0.002), minimally invasive surgery (OR 3.537, p < 0.001), and hard pancreatic texture (OR 1.480, p < 0.001). Intraoperative factors associated with non-early discharge were epidural placement (OR 0.485, p < 0.001), drain placement (OR 0.308, p < 0.001), and jejunostomy tube placement (OR 0.278, p < 0.001). Patients discharged within 5 days had a 14.7% readmission rate compared to 17.0% for later discharges (p = 0.047).
Multiple preoperative and intraoperative factors, including some that are potentially modifiable, were significantly associated with early discharge after pancreaticoduodenectomy. Patients with these characteristics may benefit from enhanced recovery after surgery programs and expedited disposition planning postoperatively.
胰十二指肠切除术是一种复杂手术，常伴有住院时间延长。然而，有一部分患者在术后5天内出院；这部分患者的术前和术中特征尚不清楚。
使用2014年至2016年的NSQIP靶向胰腺切除术数据集。排除30天内死亡的患者。共识别出10741例行胰十二指肠切除术的患者。对术前和术中的美国外科医师学会国家外科质量改进计划（ACS-NSQIP）变量进行单变量和多变量逻辑回归分析，以确定早期出院的预测因素。早期出院定义为术后3至5天出院。
共有1105例患者（10.3%）在胰十二指肠切除术后5天内出院。多变量分析显示，与早期出院相关的术前因素包括年龄较小（比值比[OR]0.988，p<0.001）、非肥胖（OR 0.737，p=0.001）、接受新辅助化疗的患者（OR 1.424，p<0.001），以及无慢性阻塞性肺疾病（COPD）（OR 0.489，p=0.005）或高血压（OR 0.805，p=0.007）。多变量分析中与早期出院相关的术中因素包括手术时间较短（OR 0.999，p=0.002）、微创手术（OR 3.537，p<0.001）和胰腺质地硬（OR 1.480，p<0.001）。与非早期出院相关的术中因素包括硬膜外置管（OR 0.485，p<0.001）、引流管置管（OR 0.308，p<0.001）和空肠造口管置管（OR 0.278，p<0.001）。5天内出院的患者再入院率为14.7%，而较晚出院的患者为17.0%（p=0.047）。
多个术前和术中因素，包括一些可能可改变的因素，与胰十二指肠切除术后早期出院显著相关。具有这些特征的患者可能从术后加速康复计划和术后加快出院计划中获益。
