Asban Ammar, Xie Rongbing, Abraham Peter, Kirklin James K, Donahue James, Wei Benjamin
Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Thorac Dis. 2020 Oct;12(10):5700-5708. doi: 10.21037/jtd-20-1210.
Many patients undergoing general thoracic surgery can be discharged on the same day as chest tube removal, but some are not, leading to increased resource utilization. This study assesses the frequency and duration of extended length of stay (ELOS) after tube removal and identifies risk factors for ELOS.
We retrospectively reviewed all adult patients undergoing general thoracic surgery at a tertiary referral medical center captured in the Society of Thoracic Surgeons General Thoracic Surgery Database and obtained detailed clinical data on chest tube management from August 2013 to April 2017. Pre-operative demographics, procedures, diagnoses, comorbidities, hospital service category, and lab values were examined to identify risk factors associated with ELOS after chest tube removal using multivariable generalized linear regression models.
One thousand and four hundred seventy patients had ≥1 chest tubes placed at the time of operation and discharged after chest tube removal: anatomic lung resection (34%), wedge resection (29%), decortication (16%), and other (21%). Fifty-one percent of these patients were male, 81% were white, and the mean age was 59 years (SD: 15 years). One-third of the patients had prior cardiothoracic operations. Twenty-three percent of these patients had ELOS, defined as discharge ≥1 calendar day after chest tube removal with a median additional hospital stay of 3 days (interquartile range, 2-7 days). A multivariable regression model demonstrated that risk factors for ELOS included being admitted to an oncology or transplant service, undergoing decortication procedure, active smoking, and increased disability.
Patients with obesity, more severe disability, or actively smoking, undergoing, decortication, admitted to transplant and oncology services were more likely to experience ELOS. These factors should be considered when identifying appropriate patient groups for fast-track algorithms.
许多接受普通胸外科手术的患者在拔除胸管的同一天即可出院，但有些患者并非如此，这导致资源利用增加。本研究评估了拔除胸管后延长住院时间（ELOS）的频率和持续时间，并确定了ELOS的危险因素。
我们回顾性分析了在胸外科医师协会普通胸外科数据库中记录的、于一家三级转诊医疗中心接受普通胸外科手术的所有成年患者，并获取了2013年8月至2017年4月期间胸管管理的详细临床数据。通过多变量广义线性回归模型，对术前人口统计学、手术、诊断、合并症、医院服务类别和实验室值进行检查，以确定与拔除胸管后ELOS相关的危险因素。
1470例患者在手术时放置了≥1根胸管，并在拔除胸管后出院：解剖性肺切除术（34%）、楔形切除术（29%）、剥脱术（16%）和其他手术（21%）。这些患者中51%为男性，81%为白人，平均年龄为59岁（标准差：15岁）。三分之一的患者曾接受过心胸手术。这些患者中有23%出现了ELOS，定义为拔除胸管后≥1个日历日出院，额外住院时间的中位数为3天（四分位间距，2 - 7天）。多变量回归模型表明，ELOS的危险因素包括入住肿瘤或移植科室、接受剥脱术、当前吸烟以及残疾程度增加。
肥胖、残疾程度更严重、当前吸烟、接受剥脱术、入住移植和肿瘤科室的患者更有可能出现ELOS。在确定适合快速康复算法的患者群体时，应考虑这些因素。
