Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Centre for the Development of Best Practices in Health, Yaoundé, Cameroon.
J Thorac Cardiovasc Surg. 2021 Jul;162(1):321-330.e1. doi: 10.1016/j.jtcvs.2020.05.095. Epub 2020 Jun 23.
Thoracic surgery is associated with significant rates of postoperative morbidity and postdischarge return to the hospital or emergency department (ED). This study aims to assess the impact of a novel integrated patient-centered, hospital-based multidisciplinary community program (Integrated Comprehensive Care [ICC]) on postdischarge outcomes in patients undergoing thoracic surgery compared to routine care.
This was a retrospective cohort study of patients who underwent surgical resection for lung malignancies at a tertiary care center from 2010 to 2014. Patients were divided into 2 cohorts based on their enrollment in the ICC program (intervention cohort; 2012-2014) or routine postoperative care (control cohort; 2010-2012). Propensity score matching was performed to match the 2 cohorts. The impact of the ICC program on postoperative length of stay (LOS), rate of ED visits, readmissions, and mortality within the first 60 days was assessed.
Of the 1288 patients included in this study, 658 (51.1%) were male patients with mean age of 64 years (standard deviation 14.1 years). After propensity score matching, 478 patients were enrolled in the ICC cohort and 592 were enrolled as controls. The ICC cohort had significantly shorter LOS (4 days, vs 5 days in controls, P = .001), lower rate of 60-day ED visits (9.8% vs 28.4% in controls, P < .001), and readmissions (6.9% vs 8.6% in controls, P < .001). The 60-day mortality was also significantly lower in the ICC cohort compared with the control group (0.6% vs 0.8% in controls, P < .001).
The ICC program is associated with shorter LOS, fewer ED visits and readmissions after discharge, and ultimately may decrease postoperative mortality.
胸外科手术后的发病率和出院后返回医院或急诊部（ED）的比例都较高。本研究旨在评估与常规护理相比，一种新型的以患者为中心的、基于医院的多学科社区项目（综合全面护理[ICC]）对胸外科手术后出院患者的出院结果的影响。
这是一项回顾性队列研究，纳入了 2010 年至 2014 年在一家三级护理中心接受肺癌切除术的患者。患者根据其是否参加 ICC 项目（干预组；2012-2014 年）或常规术后护理（对照组；2010-2012 年）分为两组。采用倾向评分匹配来匹配两组。评估 ICC 项目对术后住院时间（LOS）、ED 就诊率、再入院率和 60 天内死亡率的影响。
本研究共纳入 1288 例患者，其中 658 例（51.1%）为男性，平均年龄为 64 岁（标准差 14.1 岁）。经过倾向评分匹配，478 例患者被纳入 ICC 组，592 例患者被纳入对照组。ICC 组的 LOS 明显更短（4 天，而对照组为 5 天，P =.001），60 天内 ED 就诊率（9.8% vs 对照组的 28.4%，P <.001）和再入院率（6.9% vs 对照组的 8.6%，P <.001）更低。ICC 组的 60 天死亡率也明显低于对照组（0.6% vs 对照组的 0.8%，P <.001）。
ICC 项目与较短的 LOS、出院后较少的 ED 就诊和再入院有关，最终可能降低术后死亡率。
