Strother Marshall C, Michel Katharine F, Xia Leilei, McWilliams Kellie, Guzzo Thomas J, Lee Daniel J, Lee David I
Department of Surgery, Division of Urology, University of Pennsylvania Health System, Philadelphia, PA, USA.
Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
Ann Surg Oncol. 2020 May;27(5):1560-1567. doi: 10.1245/s10434-020-08266-3. Epub 2020 Feb 26.
Robot-assisted radical prostatectomy (RARP) can generally be performed with 1-2 nights of postoperative monitoring before discharge from the hospital. Little is known about what causes individual patients to remain in hospital beyond the second postoperative day.
Data for RARPs performed between 2013 and 2015 were extracted from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The fraction of cases with prolonged length of stay (PLOS) that can be reasonably attributed to complications was examined. Logistic regression was performed to identify risk factors for PLOS in the overall population and separately in the population of patients with PLOS without any perioperative complications.
Of 11,440 patients, 10,342 (90.4%) were discharged on postoperative days 0-2; 80.6% (887/1101) of patients with PLOS did not experience any perioperative complications. The most common complication was bleeding requiring transfusion, but this was present in only 5.6% (62/1101) of patients with PLOS. Logistic regression identified predictors of PLOS as age, race, wound class, American Society of Anesthesiologists class, smoking, diabetes, dyspnea, dependent functional health status, congestive heart failure, operative time, and pelvic lymph node dissection. Results of this regression were insensitive to the exclusion of patients who experienced no perioperative complications.
This study utilizes logistic regression on NSQIP data to identify risk factors for PLOS after RARP and, in particular, to evaluate the role of postoperative complications in PLOS. The analysis shows that postoperative complications account for a small minority of cases of PLOS after RARP.
机器人辅助根治性前列腺切除术（RARP）术后通常只需1 - 2晚的监测即可出院。对于导致个别患者术后第二天仍需住院的原因，人们知之甚少。
从美国外科医师学会国家外科质量改进计划（NSQIP）数据库中提取2013年至2015年期间进行RARP手术的数据。研究了可合理归因于并发症的住院时间延长（PLOS）病例的比例。进行逻辑回归分析，以确定总体人群以及无任何围手术期并发症的PLOS患者人群中PLOS的危险因素。
在11440例患者中，10342例（90.4%）在术后0 - 2天出院；PLOS患者中有80.6%（887/1101）未经历任何围手术期并发症。最常见的并发症是需要输血的出血，但仅在5.6%（62/1101）的PLOS患者中出现。逻辑回归分析确定PLOS的预测因素为年龄、种族、伤口类别、美国麻醉医师协会分级、吸烟、糖尿病、呼吸困难、依赖性功能健康状况、充血性心力衰竭、手术时间和盆腔淋巴结清扫术。该回归结果对排除未经历围手术期并发症的患者不敏感。
本研究利用NSQIP数据进行逻辑回归分析，以确定RARP术后PLOS的危险因素，尤其是评估术后并发症在PLOS中的作用。分析表明，术后并发症在RARP术后PLOS病例中占少数。
