Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA.
Department of Surgery, 1466Johns Hopkins University, Baltimore, MA, USA.
Am Surg. 2022 Jan;88(1):83-92. doi: 10.1177/0003134820973739. Epub 2020 Dec 28.
Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality worldwide. Liver resections and transplantations have increasingly become feasible options for potential cure. These complex surgeries are inherently associated with increased rates of readmission. In the meanwhile, hospital readmission rates are rapidly becoming an important quality of care metric. Therefore, it is very important to understand the effect of 30-day readmission on mortality and the factors associated with increased 30- and 90-day mortality rates.
This is a retrospective cohort study utilizing data from the National Cancer Database. Patients included were 18 years or older who underwent liver resection or liver transplantation for HCC between 2003 and 2011. Our primary outcomes of interest were 30- and 90-day mortality rates. Our primary independent variable of interest was 30-day readmission.
16 658 patients underwent either a liver resection or transplantation for HCC between 2003 and 2011. For patients with liver transplantations, increased readmission rates were associated with lower risks of 30-day mortality ( = .012) but a trend toward higher 90-day mortality ( = .057). Patients who underwent liver resection for HCC also demonstrated increased readmission rates to be associated with lower risk of 30-day mortality ( = .014) but higher 90-day mortality ( ≤ .001).
This is the only study to utilize a national database to investigate the association between readmission rates and mortality rates of both liver transplantations and resections for patients with HCC. We demonstrate 30-day readmission to show no increase in 30-day mortality, but rather higher 90-day mortality.
肝细胞癌（HCC）是全球癌症死亡的主要原因。肝切除术和肝移植已越来越成为潜在治愈的可行选择。这些复杂的手术与再入院率的增加密切相关。与此同时，医院再入院率正迅速成为衡量医疗质量的一个重要指标。因此，了解 30 天再入院对死亡率的影响以及与 30 天和 90 天死亡率增加相关的因素非常重要。
这是一项利用国家癌症数据库数据进行的回顾性队列研究。纳入的患者年龄在 18 岁或以上，于 2003 年至 2011 年间接受肝切除术或肝移植治疗 HCC。我们感兴趣的主要结局是 30 天和 90 天的死亡率。我们感兴趣的主要独立变量是 30 天再入院。
在 2003 年至 2011 年间，有 16658 例患者接受了肝切除术或肝移植治疗 HCC。对于接受肝移植的患者，再入院率的增加与 30 天死亡率降低相关（ =.012），但 90 天死亡率有升高趋势（ =.057）。接受 HCC 肝切除术的患者也显示出，再入院率与 30 天死亡率降低相关（ =.014），但 90 天死亡率升高（≤.001）。
这是唯一一项利用国家数据库研究 HCC 患者肝移植和肝切除术的再入院率与死亡率之间关系的研究。我们发现 30 天再入院并未增加 30 天死亡率，反而导致 90 天死亡率升高。
