Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA, USA.
Int J Colorectal Dis. 2020 Feb;35(2):249-257. doi: 10.1007/s00384-019-03487-9. Epub 2019 Dec 13.
Rectal cancer resections can be associated with long and complicated postoperative recoveries. Many patients undergoing these operations are discharged to rehabilitation or skilled nursing facilities. The purpose of this study was to identify preoperative and intraoperative factors associated with increased risk for non-home discharge after rectal cancer resection.
Rectal cancer resections were identified in the National Surgical Quality Improvement Program Targeted Proctectomy Dataset (years 2016 through 2017) by ICD code. Patients with unknown discharge destination or who experienced in-hospital mortality were excluded. Univariate and multivariate logistic regression analyses were performed to identify preoperative and intraoperative variables associated with non-home discharge destination. Multiple imputation was used to account for missing values.
Among the 3637 patients comprising the study sample, 292 (8.0%) patients were discharged to rehabilitation, skilled care, or acute care facilities. Preoperative factors associated with non-home discharge on multivariate analysis included older age, non-independent functional status, insulin-dependent diabetes, and hypoalbuminemia (all p < 0.05). Having received neoadjuvant chemotherapy was associated with home discharge (OR 0.625, 95% CI 0.427-0.914, p = 0.015). Intraoperative factors associated with non-home discharge on multivariate analysis were concurrent cystectomy (p = 0.004) and myocutaneous flap reconstruction (p < 0.001). Patients discharged to non-home facilities had longer initial lengths of stay (14.1 versus 7.0 days, p < 0.001) and higher reoperation rates (12.7 versus 5.0%, p < 0.001), but similar readmission rates (14.7 versus 15.0%, p = 1.0).
Several preoperative and intraoperative factors are associated with increased risk for non-home discharge after rectal cancer resection. These data can aid in perioperative planning and discharge optimization.
直肠癌切除术可能会导致术后恢复时间长且复杂。许多接受这些手术的患者出院后会前往康复或熟练护理机构。本研究的目的是确定与直肠癌切除术后非居家出院风险增加相关的术前和术中因素。
通过 ICD 代码在国家手术质量改进计划靶向直肠切除术数据集（2016 年至 2017 年）中确定直肠癌切除术。排除出院去向未知或院内死亡的患者。进行单变量和多变量逻辑回归分析，以确定与非居家出院目的地相关的术前和术中变量。使用多重插补法处理缺失值。
在纳入本研究的 3637 例患者中，有 292 例（8.0%）患者出院至康复、熟练护理或急性护理机构。多变量分析中与非居家出院相关的术前因素包括年龄较大、功能状态不独立、胰岛素依赖型糖尿病和低白蛋白血症（均 P<0.05）。接受新辅助化疗与居家出院相关（OR 0.625，95%CI 0.427-0.914，P=0.015）。多变量分析中与非居家出院相关的术中因素包括同时行膀胱切除术（P=0.004）和肌皮瓣重建（P<0.001）。出院至非居家机构的患者初始住院时间更长（14.1 天比 7.0 天，P<0.001），再次手术率更高（12.7%比 5.0%，P<0.001），但再入院率相似（14.7%比 15.0%，P=1.0）。
术前和术中的几个因素与直肠癌切除术后非居家出院风险增加相关。这些数据可以帮助进行围手术期规划和出院优化。
