贫困和共病对急诊普通外科手术结局的影响：一项流行病学研究。
Impact of deprivation and comorbidity on outcomes in emergency general surgery: an epidemiological study.
作者信息
Wohlgemut Jared M, Ramsay George, Griffin Russell L, Jansen Jan O
机构信息
School of Medicine, Medical Sciences and Nutrition, University of Aberdeen Division of Applied Health Sciences, Aberdeen, UK.
Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, UK.
出版信息
Trauma Surg Acute Care Open. 2020 Jul 27;5(1):e000500. doi: 10.1136/tsaco-2020-000500. eCollection 2020.
BACKGROUND
The impact of socioeconomic deprivation and comorbidities on the outcome of patients who require emergency general surgery (EGS) admission is poorly understood. The aim of this study was to examine the effect of deprivation and comorbidity on mortality, discharge destination and length of hospital stay (LOS) in patients undergoing EGS in Scotland.
METHODS
Prospectively collected data from all Scottish adult patients (aged >15 years) requiring EGS admitted between 1997 and 2016 were obtained from the Scottish Government. Data included age, sex, Scottish Index of Multiple Deprivation (SIMD), 5-year Charlson Comorbidity Index (CCI), whether an operation took place and outcomes including mortality, discharge destination and LOS. Logistic regression was used for the analysis of mortality and discharge destination and Poisson regression was used for LOS.
RESULTS
1 477 810 EGS admissions were analyzed. 16.2% were in the most deprived SIMD decile and 5.6% in the least deprived SIMD decile. 75.6% had no comorbidity, 20.3% had mild comorbidity, 2.5% had moderate comorbidity and 1.6% had severe comorbidity. 78.6% were discharged directly home. Inpatient, 30-day, 90-day and 1-year crude mortality was 1.7%, 3.7%, 7.2% and 12.4%, respectively. Logistic regression showed that severe comorbidity was associated with not being discharged directly to home (OR 0.38, 95% CI 0.37 to 0.39) and higher inpatient mortality (OR 13.74, 95% CI 13.09 to 14.42). Compared with the most affluent population, the most deprived population were less likely to be discharged directly to home (OR 0.97, 95% CI 0.95 to 0.99) and had higher inpatient mortality (OR 1.36, 95% CI 1.8 to 1.46). Poisson analysis showed that severe comorbidity (OR 1.69, 95% CI 1.68 to 1.69) and socioeconomic deprivation (OR 1.11, 95% CI 1.11 to 1.12) were associated with longer LOS.
DISCUSSION
Increased levels of comorbidity and, to a lesser extent, socioeconomic deprivation are key drivers of mortality, discharge destination and LOS following admission to an EGS service.
LEVEL OF EVIDENCE
III (prospective/retrospective with up to two negative criteria).
STUDY TYPE
Epidemiological/prognostic.
背景
社会经济剥夺和合并症对需要急诊普通外科手术（EGS）入院患者的预后影响尚不清楚。本研究的目的是探讨剥夺和合并症对苏格兰接受EGS手术患者的死亡率、出院目的地和住院时间（LOS）的影响。
方法
从苏格兰政府获取了1997年至2016年间所有需要EGS的苏格兰成年患者（年龄>15岁）的前瞻性收集数据。数据包括年龄、性别、苏格兰多重剥夺指数（SIMD）、5年查尔森合并症指数（CCI）、是否进行了手术以及包括死亡率、出院目的地和LOS在内的结局。采用逻辑回归分析死亡率和出院目的地，采用泊松回归分析LOS。
结果
分析了1477810例EGS入院病例。16.2%处于最贫困的SIMD十分位数，5.6%处于最不贫困的SIMD十分位数。75.6%无合并症，20.3%有轻度合并症，2.5%有中度合并症，1.6%有重度合并症。78.6%直接出院回家。住院、30天、90天和1年的粗死亡率分别为1.7%、3.7%、7.2%和12.4%。逻辑回归显示，重度合并症与未直接出院回家相关（比值比0.38，95%置信区间0.37至0.39）以及住院死亡率较高（比值比13.74，95%置信区间13.09至14.42）。与最富裕人群相比，最贫困人群直接出院回家的可能性较小（比值比0.97，95%置信区间0.95至0.99）且住院死亡率较高（比值比·1.36，95%置信区间1.8至1.46）。泊松分析显示，重度合并症（比值比1.69，95%置信区间1.6%至1.69）和社会经济剥夺（比值比1.11，95%置信区间1.11至1.12）与较长的LOS相关。
讨论
合并症水平的升高以及在较小程度上社会经济剥夺是EGS服务入院后死亡率、出院目的地和LOS的关键驱动因素。
证据水平
III（前瞻性/回顾性，最多有两个阴性标准）。
研究类型
流行病学/预后研究。
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