Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
PLoS One. 2020 Jul 16;15(7):e0236122. doi: 10.1371/journal.pone.0236122. eCollection 2020.
To determine the predictive factors of postoperative hospital stay and total hospital medical cost among patients who underwent total laryngectomy.
A total of 213 patients who underwent total laryngectomy in a tertiary referral center for tumor ablation were enrolled retrospectively between January 2009 and May 2018. Statistical analyses including Pearson's chi-squared test were used to determine whether there was a significant difference between each selected clinical factors and outcomes. The outcomes of interest including postoperative length of hospital stay and inpatient total medical cost. Logistic regression analyses were performed to reveal the relationship between clinical factors and postoperative length of hospital stay or total inpatient medical cost.
Preoperative radiotherapy (p = 0.007), method of wound closure (p < 0.001), postoperative serum albumin level (p = 0.025), and postoperative serum hemoglobin level (p = 0.04) were significantly associated with postoperative hospital stay in univariate analysis. Postoperative hypoalbuminemia (odds ratio [OR]: 2.477; 95% confidence interval [CI]: 1.189-5.163; p = 0.015) and previous radiotherapy history (OR 2.194; 95% CI: 1.228-3.917; p = 0.008) are independent predictors of a longer postoperative hospital stay in multiple regression analysis. With respect to total inpatient medical cost, method of wound closure (p < 0.001), preoperative serum albumin level (p = 0.04), postoperative serum albumin level (p < 0.001), and history of liver cirrhosis (p = 0.037) were significantly associated with total inpatient medical cost in univariate analysis. Postoperative hypoalbuminemia (OR: 6.671; 95% CI: 1.927-23.093; p = 0.003) and microvascular free flap reconstruction (OR: 5.011; 95% CI: 1.657-15.156; p = 0.004) were independent predictors of a higher total inpatient medical cost in multiple regression analysis.
Postoperative albumin status is a significant factor in predicting prolonged postoperative hospital stay and higher inpatient medical cost among patients who undergo total laryngectomy. In this cohort, the inpatient medical cost was 48% higher and length of stay after surgery was 35% longer among hypoalbuminemia patients.
确定行全喉切除术患者的术后住院时间和总住院医疗费用的预测因素。
回顾性纳入 2009 年 1 月至 2018 年 5 月在一家三级肿瘤消融转诊中心行全喉切除术的 213 例患者。采用 Pearson's chi-squared 检验对每个选定的临床因素与结果之间是否存在显著差异进行统计学分析。本研究的主要结局包括术后住院时间和住院总医疗费用。采用 logistic 回归分析揭示临床因素与术后住院时间或总住院医疗费用之间的关系。
单因素分析显示，术前放疗（p = 0.007）、伤口闭合方式（p < 0.001）、术后血清白蛋白水平（p = 0.025）和术后血清血红蛋白水平（p = 0.04）与术后住院时间显著相关。术后低白蛋白血症（比值比 [OR]：2.477；95%置信区间 [CI]：1.189-5.163；p = 0.015）和既往放疗史（OR 2.194；95% CI：1.228-3.917；p = 0.008）是术后住院时间延长的独立预测因素。对于总住院医疗费用，伤口闭合方式（p < 0.001）、术前血清白蛋白水平（p = 0.04）、术后血清白蛋白水平（p < 0.001）和肝硬化病史（p = 0.037）在单因素分析中与总住院医疗费用显著相关。术后低白蛋白血症（OR：6.671；95% CI：1.927-23.093；p = 0.003）和微血管游离皮瓣重建（OR：5.011；95% CI：1.657-15.156；p = 0.004）是多因素回归分析中总住院医疗费用较高的独立预测因素。
术后白蛋白状态是预测行全喉切除术患者术后住院时间延长和住院医疗费用增加的重要因素。在本队列中，低白蛋白血症患者的住院医疗费用增加 48%，术后住院时间延长 35%。
