Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Ann Thorac Surg. 2021 Aug;112(2):379-386. doi: 10.1016/j.athoracsur.2020.11.020. Epub 2020 Dec 11.
Frequent emergency department (ED) visits occur after esophagectomy. We aimed to identify the incidence of and risk factors for conversion from ED visit to inpatient admission.
A retrospective cohort study was performed of consecutive esophagectomies at a tertiary Canadian center (1999 to 2014). Multivariable regression analyses identified factors associated with conversion from ED visit to admission.
There were 520 esophagectomies with 6% inhospital mortality (n = 31). Of those discharged, 29.7% (n = 145) had one or more emergency visit and 43.4% (n = 63) of these patients were readmitted to the hospital. First-time ED visits resulted in inpatient conversion 23.4% of the time (n = 34); successive ED visits resulted in increasing conversion. On multivariable analysis, anastomotic leak (adjusted odds ratio 2.45; 95% confidence interval, 1 to 6.01; P = .05) was independently associated with higher odds of conversion to admission. Sensitivity analysis using Poisson regression to model conversion as a rate identified that living in regions further away was associated with lower conversion rate to admission (risk ratio 0.35; 95% confidence interval, 0.13 to 0.94; P = .04).
Although postesophagectomy ED utilization is high, the majority of visits do not convert to admission. With each increasing ED visit, likelihood of converting to admission increases. Anastomotic leakage was associated with higher odds of conversion to admission, possibly related to development of strictures. Access to urgent outpatient endoscopy may help reduce the incidence of ED visits and admission. Although living in regions further away is associated with lower conversion rates to admission at the index hospital, that may be due to patients utilizing closer local hospitals.
食管切除术后常需频繁到急诊科（ED）就诊。本研究旨在确定 ED 就诊后转为住院的发生率和相关危险因素。
对加拿大一家三级医院（1999 年至 2014 年）连续进行的食管切除术患者进行回顾性队列研究。多变量回归分析确定了 ED 就诊转为住院的相关因素。
共进行了 520 例食管切除术，院内死亡率为 6%（n=31）。出院患者中，29.7%（n=145）有 1 次或多次急诊就诊，其中 43.4%（n=63）的患者再次住院。首次 ED 就诊中有 23.4%（n=34）转为住院；再次 ED 就诊的患者转为住院的比例逐渐升高。多变量分析显示，吻合口漏（调整优势比 2.45；95%置信区间，1 至 6.01；P=.05）与更高的住院转化率独立相关。使用泊松回归模型对转化率进行分析的敏感性研究表明，居住在更远地区与较低的住院转化率相关（风险比 0.35；95%置信区间，0.13 至 0.94；P=.04）。
尽管食管切除术后 ED 的使用频率很高，但大多数就诊不会转为住院。随着 ED 就诊次数的增加，转为住院的可能性增加。吻合口漏与更高的住院转化率相关，可能与狭窄的发生有关。紧急门诊内镜检查的获得可能有助于减少 ED 就诊和住院的发生率。尽管在索引医院，居住在更远地区与较低的住院转化率相关，但这可能是由于患者利用了更近的当地医院。
