Division of General and Gastrointestinal Surgery, The Ohio State Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
Surg Endosc. 2020 May;34(5):2149-2157. doi: 10.1007/s00464-019-06953-1. Epub 2019 Jul 12.
Post-operative non-urgent hospital visits (NUR-HV) are an important quality target for reducing unnecessary healthcare utilization. The primary objective of this study was to characterize 90-day post-operative hospital use and determine independent predictors for NUR-HV and urgent (UR)-HV after elective laparoscopic paraesophageal hernia repair (LPEHR) and Nissen Fundoplication (LNF).
Five hundred and sixty-two primary LPEHR and LNF patients were retrospectively reviewed at a single institution. Ninety-day NUR-HV and UR-HV were compared to patients without post-operative HV using baseline medical and demographic data, preoperative work-up (manometry, pH testing, disease-specific quality of life and symptom scale scores (GERSS), and hospital course. Multiple logistic models were created using univariate associations (p < 0.1) to model independent predictors of NUR-HV and UR-HV.
NUR-HV accounted for 52% (n = 30) of all 90-HV, while the remaining were UR-HV (n = 28, 48.3%). Compared to controls, NUR-HV were younger (51.2 ± 16.8 years vs. 57.6 ± 15.2, p = 0.05), had a lower baseline BMI (28.2 ± 6.4 vs. 31.3 ± 5.4, p = 0.003) and ASA scores (p = 0.02), presented with higher GERSS (46 (28-60) vs. 35 (19-48), p = 0.02) and dysphagia scores (3 (1-5) vs. 2 (0-4), p = 0.02), were associated with LNF (77.7% vs. 54.6%, p = 0.02), and experienced more post-operative dysphagia (13.3% vs. 4.6%, p = 0.06). UR-HV were older (64.0 ± 13.2 vs. 57.6 ± 15.2, p = 0.03), associated with LPEHR (67.9% vs. 45.4%, p = 0.02), longer hospital stay (2 (1-3) vs. 1 (1-2), p = 0.003), and increased overall (39.3% vs. 15.1%, p = 0.001) and urgent complications (34.6% vs. 8.3%, p < 0.005). Positive predictors of NUR-HV included ASA score < 3 (OR 4.4, p = 0.02), increasing GERSS (1.04, p = 0.01), and reduced peristalsis (OR 4.7, p = 0.01), while UR-HV were independently predicted by urgent complications (5.0, p < 0.00005).
NUR-HV accounted for half of post-operative visits following LNF/LPEHR and were predicted by distinct characteristics compared to UR-HV. This stratification provides novel insight that will guide both preoperative counseling and post-operative quality initiatives.
术后非紧急医院就诊（NUR-HV）是减少不必要医疗保健利用的一个重要质量目标。本研究的主要目的是描述择期腹腔镜食管裂孔疝修补术（LPEHR）和 Nissen 胃底折叠术（LNF）后 90 天的术后医院使用情况，并确定 NUR-HV 和紧急（UR）-HV 的独立预测因素。
对单中心的 562 例原发性 LPEHR 和 LNF 患者进行回顾性分析。使用基线医疗和人口统计学数据、术前检查（测压、pH 测试、疾病特异性生活质量和症状量表评分（GERSS）以及住院过程）比较 90 天内 NUR-HV 和 UR-HV 与无术后 HV 的患者。使用单变量关联（p<0.1）创建多元逻辑模型，以建立 NUR-HV 和 UR-HV 的独立预测因素。
NUR-HV 占所有 90-HV 的 52%（n=30），其余为 UR-HV（n=28，占 48.3%）。与对照组相比，NUR-HV 更年轻（51.2±16.8 岁 vs. 57.6±15.2 岁，p=0.05），基线 BMI（28.2±6.4 与 31.3±5.4，p=0.003）和 ASA 评分（p=0.02）较低，GERSS（46（28-60）与 35（19-48），p=0.02）和吞咽困难评分（3（1-5）与 2（0-4），p=0.02）较高，与 LNF（77.7% 与 54.6%，p=0.02）相关，术后吞咽困难发生率更高（13.3%与 4.6%，p=0.06）。UR-HV 年龄较大（64.0±13.2 岁 vs. 57.6±15.2 岁，p=0.03），与 LPEHR（67.9% 与 45.4%，p=0.02）相关，住院时间更长（2（1-3）与 1（1-2），p=0.003），总并发症发生率更高（39.3%与 15.1%，p=0.001）和紧急并发症发生率更高（34.6%与 8.3%，p<0.005）。NUR-HV 的阳性预测因素包括 ASA 评分<3（OR 4.4，p=0.02）、GERSS 增加（1.04，p=0.01）和蠕动减少（OR 4.7，p=0.01），而 UR-HV 则由紧急并发症独立预测（5.0，p<0.00005）。
NUR-HV 占 LNF/LPEHR 术后就诊的一半，与 UR-HV 相比，有其独特的预测特征。这种分层提供了新的见解，将指导术前咨询和术后质量计划。
