Yu Jennifer, Olsen Margaret A, Margenthaler Julie A
Section of Endocrine and Oncologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Breast J. 2020 Oct;26(10):1966-1972. doi: 10.1111/tbj.14029. Epub 2020 Aug 26.
We investigated the impact of patient and operative factors on 30-day hospital readmission following mastectomy for breast cancer. Using the 2011 HCUP California State Inpatient Database, we evaluated readmissions in adult women undergoing mastectomy for invasive, in situ, or history of breast cancer. Clinical data assessment was performed using ICD-9-CM codes and the Elixhauser comorbidity index. Chi-square tests and logistic regression were used to analyze patient and operative factors and associations with 30-day hospital readmission. Of 6214 women undergoing mastectomy, 306 (4.9%) were readmitted within 30 days postoperatively, most commonly for surgical site infection (130, 42.5%) and hematoma (29, 9.5%). 30-day readmission was associated with increasing index length of stay (LOS), comorbidities, and non-private insurance (P < .05). Age, mastectomy type (unilateral vs bilateral, with vs without lymph node assessment), immediate reconstruction, and port placement during the index procedure did not significantly influence the odds of 30-day readmission. Multivariable logistic regression showed increased odds of readmission with index LOS > 2 days (OR 1.81, P < .01), metastatic disease (OR 2.16, P = .01), and Medicare insurance (OR 1.72, P < .01). Index LOS > 2 days, metastatic disease, and Medicare insurance are significant predictors of 30-day readmission following mastectomy for breast cancer. Surgical site infection and wound complications were the most common diagnoses requiring readmission and resulted in over half of readmissions in our study population at 30 days.
我们调查了患者因素和手术因素对乳腺癌乳房切除术后30天内再次入院的影响。利用2011年加州医疗保健利用项目（HCUP）的加利福尼亚州住院患者数据库，我们评估了因浸润性、原位或有乳腺癌病史而接受乳房切除术的成年女性的再次入院情况。使用国际疾病分类第九版临床修正版（ICD-9-CM）编码和埃利克斯豪泽共病指数进行临床数据评估。采用卡方检验和逻辑回归分析患者和手术因素以及与30天内再次入院的相关性。在6214名接受乳房切除术的女性中，306名（4.9%）在术后30天内再次入院，最常见的原因是手术部位感染（130例，42.5%）和血肿（29例，9.5%）。30天再次入院与指数住院时间（LOS）延长、共病以及非私人保险相关（P < 0.05）。年龄、乳房切除类型（单侧与双侧、有与无淋巴结评估）、即刻重建以及在初次手术过程中放置端口并未显著影响30天再次入院的几率。多变量逻辑回归显示，指数住院时间>2天（比值比[OR] 1.81，P < 0.01）、转移性疾病（OR 2.16，P = 0.01）以及医疗保险（OR 1.72，P < 0.01）会增加再次入院的几率。指数住院时间>2天、转移性疾病和医疗保险是乳腺癌乳房切除术后30天再次入院的重要预测因素。手术部位感染和伤口并发症是需要再次入院的最常见诊断，并且在我们的研究人群中导致了30天时超过一半的再次入院情况。
