Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, Division of Cardiac Surgery, University of California, Los Angeles, California.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California, Los Angeles, California.
J Surg Oncol. 2020 Nov;122(6):1199-1206. doi: 10.1002/jso.26137. Epub 2020 Jul 22.
Postoperative readmissions are often used to assess quality of surgical care. This study compared 30-day vs 31- to 90-day readmission following surgery for ovarian, fallopian tube, or primary peritoneal cancer.
This retrospective study of the 2010-2015 Nationwide Readmissions Database characterized 90-day readmissions following cytoreductive surgery for these cancers. Each patient's first postoperative hospitalization was included. Univariate analysis compared patient demographics and reasons for readmission. Multivariable regression identified independent predictors of readmission.
Of an estimated 76 652 patients, 10 264 (13.4%) were readmitted within 30 days, and 6942 (9.1%) between 31 and 90 days. The 30-day readmissions were more frequently associated with postoperative infection, while 31- to 90-day readmissions were more frequently associated with renal or hematologic diagnoses. Predictors of any 90-day readmission included index hospitalization longer than 7 days (adjusted odds ratio (AOR) 1.61 [1.48-1.75], P < .001), extended surgical procedure (AOR 1.41 [1.30-1.53], P < .001), pulmonary circulation disorder (AOR = 1.34 [1.13-1.60], P = .001), and diabetes mellitus (AOR = 1.12 [1.02-1.24], P = .020).
Readmission rates remain high during the 31- to 90-day postoperative period in ovarian cancer patients, although these readmissions are less frequently related to postoperative complications. Prospective study is merited to optimize surveillance beyond the initial 30 days after ovarian cancer surgery.
术后再入院通常用于评估手术护理质量。本研究比较了卵巢癌、输卵管癌或原发性腹膜癌患者手术后 30 天和 31-90 天的再入院率。
本研究回顾性分析了 2010-2015 年全国再入院数据库中这些癌症患者进行细胞减灭术后 90 天内的再入院情况。纳入每位患者首次术后住院治疗的资料。单变量分析比较了患者的人口统计学资料和再入院的原因。多变量回归确定了再入院的独立预测因素。
在估计的 76652 例患者中，有 10264 例（13.4%）在 30 天内再入院，6942 例（9.1%）在 31-90 天内再入院。30 天内的再入院更多与术后感染相关，而 31-90 天内的再入院更多与肾脏或血液学诊断相关。任何 90 天再入院的预测因素包括住院时间超过 7 天（调整后的优势比（AOR）1.61[1.48-1.75]，P<0.001）、手术时间延长（AOR 1.41[1.30-1.53]，P<0.001）、肺循环障碍（AOR=1.34[1.13-1.60]，P=0.001）和糖尿病（AOR=1.12[1.02-1.24]，P=0.020）。
卵巢癌患者在手术后 31-90 天的再入院率仍然很高，尽管这些再入院与术后并发症的关系较少。需要前瞻性研究来优化卵巢癌手术后最初 30 天之后的监测。
