Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2019 Sep;158(3):934-942.e2. doi: 10.1016/j.jtcvs.2019.04.061. Epub 2019 May 3.
Readmission following esophagectomy affects the patient experience, has important economic implications, and can be tied to hospital reimbursement. Ontario has regionalized thoracic centers; regionalized surgery may lower the readmission rate. We investigated whether surgery at regionalized thoracic centers is associated with reduced readmission following esophageal cancer resection.
A retrospective, population-based cohort study (2002-2014) was conducted in Ontario, Canada (population 13.6 million). Adults with resected esophageal cancer were identified through the Ontario Cancer Registry. Multivariable regression was used to estimate the effect of surgery at a regionalized thoracic surgery center on readmission to any Ontario hospital within 90 days following discharge.
Of 3670 patients, 27.9% were readmitted within 90 days of discharge (n = 1022). Median hospital length of stay was 12 days (interquartile range 9-20). The readmission rate at thoracic centers was similar to other hospitals (28.1% vs 27.1%, P = .57). The readmission rate did not change during the 13-year study period. Case-mix adjusted readmission rates varied from 17.6% to 35.2% even across thoracic centers and were not related to hospital volume or perioperative mortality. After adjusting for confounders, we found that surgery at a thoracic center was not significantly associated with readmission (odds ratio, 1.10; 95% confidence interval, 0.95-1.27, P = .22).
Surgery at a designated thoracic surgery center did not reduce the risk of 90-day readmission following esophageal cancer resection, and readmission rates varied significantly even across thoracic centers. Our results suggest that despite universal, regionalized esophageal cancer care, there appears to be a minimum readmission threshold following esophagectomy that may be clinically necessary.
食管癌切除术后的再入院会影响患者的体验，具有重要的经济意义，并可能与医院的报销有关。安大略省已经实现了胸外科的区域中心化；区域化手术可能会降低再入院率。我们研究了在区域化胸科中心进行手术是否与降低食管癌切除术后的再入院率有关。
这是一项在加拿大安大略省进行的回顾性、基于人群的队列研究（2002 年至 2014 年）（人口 1360 万）。通过安大略省癌症登记处确定接受食管癌切除术的成年人。使用多变量回归来估计在区域化胸外科中心进行手术对出院后 90 天内任何安大略省医院再入院的影响。
在 3670 名患者中，有 27.9%（n=1022）在出院后 90 天内再次入院。中位住院时间为 12 天（四分位间距为 9-20）。胸科中心的再入院率与其他医院相似（28.1%比 27.1%，P=0.57）。在 13 年的研究期间，再入院率没有变化。即使在胸科中心之间，病例组合调整后的再入院率也从 17.6%到 35.2%不等，且与医院容量或围手术期死亡率无关。调整混杂因素后，我们发现胸科中心的手术与再入院无显著相关性（比值比，1.10；95%置信区间，0.95-1.27，P=0.22）。
在指定的胸外科中心进行手术并不能降低食管癌切除术后 90 天内再入院的风险，即使在胸科中心之间，再入院率也有很大差异。我们的研究结果表明，尽管有普遍的、区域化的食管癌治疗，但是食管癌手术后似乎存在一个最低的再入院门槛，这可能是临床所必需的。
