Johnston Stephen S, Jamous Nadine, Mistry Sameer, Jain Simran, Gangoli Gaurav, Danker Walter, Ammann Eric, Hampton Kingsley
Department of Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA.
Department of Health Economics and Market Access, Johnson & Johnson Medical Ltd, Edinburgh, UK.
Clinicoecon Outcomes Res. 2021 Jan 8;13:19-29. doi: 10.2147/CEOR.S287970. eCollection 2021.
To evaluate the association of in-hospital surgical bleeding events with the outcomes of hospital length of stay (LOS), days spent in critical care, complications, and mortality among patients undergoing neoplasm-directed surgeries in English hospitals.
This is a retrospective cohort study using English hospital discharge data (Hospital Episode Statistics [HES]) linked to electronic health records (Clinical Practice Research Datalink [CPRD]). HES includes information on patient demographics, admission and discharge dates, diagnoses and procedures, days spent in critical care, and discharge status. CPRD includes information on patient demographics, diagnoses and symptoms, drug exposures, vaccination history, and laboratory tests. Patients aged ≥18 years who underwent selected neoplasm-directed surgeries between 1-Jan-2010 and 29-February-2016: hysterectomy, low anterior resection (LAR), lung resection, mastectomy, and prostate surgery were included. The primary independent variable was in-hospital surgical bleeding events identified by diagnosis of haemorrhage and haematoma complicating a procedure or reopening/re-exploration and surgical arrest of postoperative bleeding. Outcomes included LOS, days spent in critical care, in-hospital complications (diagnoses of infections, acute renal failure, vascular events), and in-hospital mortality, identified during surgery through discharge. Multivariable regression was used to examine the adjusted association of bleeding events with outcomes.
The study included 26,437 neoplasm-directed surgeries (hysterectomy=6092; LAR=2957; lung=1538; mastectomy=12,806; prostate=3044). Incidence proportions of bleeding events were: hysterectomy=1.9% (95% confidence interval=1.1-2.5%); LAR=3.0% (CI=2.3-3.6%); lung=1.8% (CI=1.1-2.5%); mastectomy=1.6% (CI=1.3-1.8%); prostate=1.0% (CI=0.6-1.3%). In adjusted analyses, bleeding events were associated with: prolonged LOS: 3.1 (CI=1.1-6.3) mastectomy to 5.7 (CI=3.6-8.2) LAR days longer; more days spent in critical care: 0.4 (CI=0.03-0.27) mastectomy to 6.5 (CI=2.5-13.6) hysterectomy days more; and higher incidence proportions of all examined complications; all <0.05.
This study quantifies a substantial clinical and healthcare resource utilization burden associated with surgical bleeding among patients undergoing neoplasm-directed surgery in England hospitals.
评估英国医院接受肿瘤定向手术患者的院内手术出血事件与住院时间（LOS）、重症监护天数、并发症及死亡率之间的关联。
这是一项回顾性队列研究，使用与电子健康记录（临床实践研究数据链[CPRD]）相链接的英国医院出院数据（医院事件统计[HES]）。HES包括患者人口统计学信息、入院和出院日期、诊断和手术、重症监护天数及出院状态。CPRD包括患者人口统计学信息、诊断和症状、药物暴露、疫苗接种史及实验室检查。纳入2010年1月1日至2016年2月29日期间接受选定肿瘤定向手术（子宫切除术、低位前切除术[LAR]、肺切除术、乳房切除术和前列腺手术）的≥18岁患者。主要自变量是通过诊断出血和血肿并发手术或重新手术/再次探查以及术后出血的手术止血确定的院内手术出血事件。结局包括住院时间、重症监护天数、院内并发症（感染、急性肾衰竭、血管事件诊断）及院内死亡率，从手术到出院期间确定。采用多变量回归分析出血事件与结局之间的校正关联。
该研究纳入26437例肿瘤定向手术（子宫切除术=6092例；LAR=2957例；肺切除术=1538例；乳房切除术=12806例；前列腺手术=3044例）。出血事件的发生率为：子宫切除术=1.9%（95%置信区间=1.1 - 2.5%）；LAR=3.0%（CI=2.3 - 3.6%）；肺切除术=1.8%（CI=1.1 - 2.5%）；乳房切除术=1.6%（CI=1.3 - 1.8%）；前列腺手术=1.0%（CI=0.6 - 1.3%）。在校正分析中，出血事件与以下情况相关：住院时间延长：乳房切除术延长3.1天（CI=1.1 - 6.3）至LAR延长5.7天（CI=3.6 - 8.2）；重症监护天数增加：乳房切除术增加0.4天（CI=0.03 - 0.27）至子宫切除术增加6.5天（CI=2.5 - 13.6）；所有检查并发症的发生率更高；所有P<0.05。
本研究量化了英国医院接受肿瘤定向手术患者手术出血相关的巨大临床和医疗资源利用负担。
