von Meyenfeldt Erik M, Hoeijmakers Fieke, Marres Geertruid M H, van Thiel Eric R E, Marra Elske, Marang-van de Mheen Perla J, Schreurs Hermien W H
Department of Thoracic Surgery, Lung Cancer Centre, Albert Schweitzer Hospital, Dordrecht, Netherlands.
Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands.
Eur J Cardiothorac Surg. 2020 Apr 1;57(4):747-753. doi: 10.1093/ejcts/ezz303.
Good perioperative care is aimed at rapid recovery, without complications or readmissions. Length of stay (LOS) is influenced not only by perioperative care routines but also by patient factors, tumour factors, treatment characteristics and complications. The present study examines variation in LOS between hospitals after minimally invasive lung resections for both complicated and uncomplicated patients to assess whether LOS is a hospital characteristic influenced by local perioperative routines or other factors.
Dutch Lung Cancer Audit (surgery) data were used. Median LOS was calculated on hospital level, stratified by the severity of complications. Lowest quartile (short) LOS per hospital, corrected for case-mix factors by multivariable logistic regression, was presented in funnel plots. We correlated short LOS in complicated versus uncomplicated patients to assess whether short LOS clustered in the same hospitals regardless of complications.
Data from 6055 patients in 42 hospitals were included. Median LOS in uncomplicated patients varied from 3 to 8 days between hospitals and increased most markedly for patients with major complications. Considerable between-hospital variation persisted after case-mix correction, but more in uncomplicated than complicated patients. Short LOS in uncomplicated and complicated patients were significantly correlated (r = 0.53, P < 0.001).
LOS after minimally invasive anatomical lung resections varied between hospitals particularly in uncomplicated patients. The significant correlation between short LOS in uncomplicated and complicated patients suggests that LOS is a hospital characteristic potentially influenced by local processes. Standardizing and optimizing perioperative care could help limit practice variation with improved LOS and complication rates.
良好的围手术期护理旨在实现快速康复，且无并发症或再次入院情况。住院时间（LOS）不仅受围手术期护理常规的影响，还受患者因素、肿瘤因素、治疗特征和并发症的影响。本研究调查了复杂和非复杂患者接受微创肺切除术后各医院之间住院时间的差异，以评估住院时间是否是受当地围手术期常规或其他因素影响的医院特征。
使用荷兰肺癌审计（手术）数据。在医院层面计算中位住院时间，并按并发症严重程度分层。通过多变量逻辑回归校正病例组合因素后，在漏斗图中呈现每家医院最低四分位数（短）住院时间。我们将复杂和非复杂患者的短住院时间进行关联，以评估短住院时间是否在同一医院聚集，而与并发症无关。
纳入了42家医院6055例患者的数据。非复杂患者的中位住院时间在不同医院之间为3至8天，主要并发症患者的住院时间增加最为明显。病例组合校正后，医院之间仍存在相当大的差异，但非复杂患者比复杂患者更明显。非复杂和复杂患者的短住院时间显著相关（r = 0.53，P < 0.001）。
微创解剖性肺切除术后的住院时间在不同医院之间存在差异，尤其是在非复杂患者中。非复杂和复杂患者短住院时间之间的显著相关性表明，住院时间是一个可能受当地流程影响的医院特征。标准化和优化围手术期护理有助于限制实践差异，同时改善住院时间和并发症发生率。
