Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.
Department of Microbiology, Beaumont Hospital, Dublin, Ireland.
Dis Colon Rectum. 2019 Jun;62(6):703-710. doi: 10.1097/DCR.0000000000001355.
Unplanned readmission after surgery negatively impacts surgical recovery. Few studies have sought to define predictors of readmission in a rectal cancer cohort alone. Readmission following rectal cancer surgery may be reduced by the identification and modification of factors associated with readmission.
This study seeks to characterize the predictors of 30-day readmission following proctectomy for rectal cancer.
This study is a retrospective analysis of prospectively gathered cohort data. Outcomes were compared between readmitted and nonreadmitted patients. Multivariate analysis of factors association with readmission was performed by using binary logistic regression.
This study was conducted at Beaumont Hospital, a nationally designated, publicly funded cancer center.
Two hundred forty-six consecutive patients who underwent proctectomy for rectal cancer between January 2012 and December 2015 were selected.
The primary outcomes measured were readmission within 30 days of discharge and the variables associated with readmission, categorized into patient factors, perioperative factors, and postoperative factors.
Thirty-one (12.6%) patients were readmitted within 30 days of discharge following index rectal resection. The occurrence of anastomotic leaks, high-output stoma, and surgical site infections was significantly associated with readmission within 30 days (anastomotic leak OR 3.60, p = 0.02; high-output stoma OR 11.04, p = 0.003; surgical site infections OR 13.39, p = 0.01). Surgical site infections and high-output stoma maintained significant association on multivariate analysis (surgical site infections OR 10.02, p = 0.001; high-output stoma OR 9.40, p = 0.02). No significant difference was noted in the median length of stay or frequency of prolonged admissions (greater than 24 days) between readmitted and nonreadmitted patients.
The institutional database omits a number of socioeconomic factors and comorbidities that may influence readmission, limiting our capacity to analyze the relative contribution of these factors to our findings.
An early postoperative care bundle to detect postoperative complications could prevent some unnecessary inpatient admissions following proctectomy. Key constituents should include early identification and management of stoma-related complications and surgical site infection. See Video Abstract at http://links.lww.com/DCR/A912.
手术后计划外再入院会对手术恢复产生负面影响。很少有研究试图单独定义直肠癌患者再入院的预测因素。通过识别和修改与再入院相关的因素，可以减少直肠癌手术后的再入院。
本研究旨在描述直肠前切除术后 30 天内再入院的预测因素。
这是一项前瞻性收集队列数据的回顾性分析。对再入院和非再入院患者的结局进行比较。采用二元逻辑回归对再入院相关因素进行多变量分析。
这项研究在 Beaumont 医院进行，该医院是一家全国指定的、由公共资金资助的癌症中心。
选择了 2012 年 1 月至 2015 年 12 月期间接受直肠切除术的 246 例连续患者。
主要观察指标是出院后 30 天内再入院和与再入院相关的变量，分为患者因素、围手术期因素和术后因素。
31 例（12.6%）患者在指数直肠切除术后 30 天内出院后再入院。吻合口漏、高输出造口和手术部位感染的发生与 30 天内再入院显著相关（吻合口漏 OR 3.60，p = 0.02；高输出造口 OR 11.04，p = 0.003；手术部位感染 OR 13.39，p = 0.01）。手术部位感染和高输出造口在多变量分析中仍具有显著相关性（手术部位感染 OR 10.02，p = 0.001；高输出造口 OR 9.40，p = 0.02）。再入院和非再入院患者的中位住院时间或延长住院时间（大于 24 天）的频率无显著差异。
机构数据库忽略了一些可能影响再入院的社会经济因素和合并症，限制了我们分析这些因素对我们发现的相对贡献的能力。
一个早期的术后护理包来检测术后并发症，可以防止一些不必要的住院治疗后直肠前切除术。关键组成部分应该包括早期识别和管理造口相关并发症和手术部位感染。见视频摘要在http://links.lww.com/DCR/A912。
