分析转移性脊柱肿瘤手术后 2 年内非计划性住院再入院情况。
Analysis of unplanned hospital readmissions up to 2-years after metastatic spine tumour surgery.
机构信息
Department of Orthopaedic Surgery, National University Health System, Level 11 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore.
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Block MD11, Clinical Research Centre, 10 Medical Drive, Singapore, 117597, Singapore.
出版信息
Eur Spine J. 2021 Oct;30(10):2887-2895. doi: 10.1007/s00586-021-06723-5. Epub 2021 Jan 18.
PURPOSE
The aim of this study was to investigate rates, causes, and risk factors of unplanned hospital readmissions (UHR) within 30 days, 90 days, 1 year and 2 years after metastatic spine tumour surgery (MSTS) to augment multi-disciplinary treatment planning and improve patient education.
METHODS
We retrospectively reviewed 272-patients who underwent MSTS between 2005 and 2016. Hospital records were utilised to obtain demographics, oncological, procedural details, and postoperative outcomes. All UHR within 2 years were reviewed. Primary outcomes were rates, causes, and risk factors of UHR. Risk factors for UHR were evaluated utilising multivariate logistic regression analysis.
RESULTS
Thirty-day, 90 day, 1 year, and 2 year UHR-rates after MSTS were 17.2%, 31.1%, 46.2%, and 52.7%, respectively. Lung cancer primaries had the highest UHR-events (24.7%) whilst renal/thyroid displayed the least (6.6%). Disease-related causes (16.2%) were the most common reason for readmissions across all timeframes, followed by respiratory (13.7%) and progression of metastatic spine disease (12.7%). Urological conditions accounted for majority of readmissions within 30-days; disease-related causes, symptomatic spinal metastases, and respiratory conditions represented the most common causes at 30-90 days, 90 days-1 year, and 1-2 years, respectively. An ECOG >1 (p = 0.057), CCI >7 (p = 0.01), and primary lung tumour (p = 0.02) significantly increased UHR-risk on multivariate analysis.
CONCLUSION
Seventy-four percent of patients had at least one UHR within 2 years of MSTS and majority were secondary to disease-related causes. Majority of first UHR occurred between 30 and 90 days post-surgery. Local disease progression and overall disease progression account for the highest UHR-events at 90 days-1 year and 1-2 year timeframes, respectively. We define UHR in specific timeframes, thus enabling better surveillance and reducing unnecessary morbidity.
目的
本研究旨在调查 2005 年至 2016 年间接受转移性脊柱肿瘤手术（MSTS）的 272 例患者术后 30 天、90 天、1 年和 2 年内计划性再入院（UHR）的发生率、原因和危险因素，以增强多学科治疗计划并改善患者教育。
方法
我们回顾性分析了 272 例患者的病历，以获取人口统计学、肿瘤学、手术细节和术后结果。回顾了 2 年内所有 UHR。主要结果是 UHR 的发生率、原因和危险因素。利用多变量逻辑回归分析评估 UHR 的危险因素。
结果
MSTS 后 30 天、90 天、1 年和 2 年的 UHR 发生率分别为 17.2%、31.1%、46.2%和 52.7%。肺癌原发肿瘤的 UHR 发生率最高（24.7%），而肾/甲状腺肿瘤的发生率最低（6.6%）。疾病相关原因（16.2%）是所有时间范围内再入院的最常见原因，其次是呼吸系统疾病（13.7%）和转移性脊柱疾病进展（12.7%）。泌尿系统疾病是 30 天内再入院的主要原因；疾病相关原因、症状性脊柱转移和呼吸系统疾病分别是 30-90 天、90 天-1 年和 1-2 年最常见的原因。ECOG >1（p=0.057）、CCI>7（p=0.01）和原发性肺肿瘤（p=0.02）在多变量分析中显著增加了 UHR 风险。
结论
74%的患者在 MSTS 后 2 年内至少有一次 UHR，且大多数是由疾病相关原因引起的。大多数首次 UHR 发生在术后 30-90 天。局部疾病进展和总疾病进展分别占 90 天-1 年和 1-2 年时间框架内 UHR 发生率最高的原因。我们在特定时间范围内定义 UHR，从而能够更好地进行监测并减少不必要的发病率。
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