Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA.
AHN Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA.
Ann Surg Oncol. 2021 Sep;28(9):5287-5296. doi: 10.1245/s10434-020-09547-7. Epub 2021 Jan 23.
Ninety-day hospital readmission rates following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) range from 20 to 40%.
The aim of this study was to develop and validate a simple score to predict readmissions following CRS/HIPEC.
Using a prospectively maintained database, we retrospectively reviewed clinicopathologic, perioperative, and day-of-discharge data for patients undergoing CRS/HIPEC for peritoneal surface malignancies between 2010 and 2018. In-hospital mortalities and discharges to hospice were excluded. Multivariate logistic regression was utilized to identify predictors of unplanned readmission, with three-quarters of the sample randomly selected as the derivation cohort and one-quarter as the validation cohort. Using regression coefficient-based scoring methods, we developed a weighted 7-factor, 10-point predictive score for risk of readmission.
Overall, 1068 eligible discharges were analyzed; 379 patients were readmitted within 90 days (35.5%). Seven factors were associated with readmission: stoma creation, Peritoneal Cancer Index score ≥ 15, hyponatremia, in-hospital major complication, preoperative chemotherapy, anemia, and discharge to nursing home. In the validation cohort, 25 patients (9.2%) were categorized as high risk for readmission, with a predicted rate of readmission of 69.3% and an observed rate of 76.0%. The score had fair discrimination (area under the curve 0.70) and good calibration (Hosmer-Lemeshow goodness-of-fit p-value of 0.77).
Our proposed risk score, easily obtainable on day of discharge, distinguishes patients at high risk for readmission over 90 days following CRS/HIPEC. This score has the potential to target high-risk individuals for intensive follow-up and other interventions.
细胞减灭术和腹腔热灌注化疗（CRS/HIPEC）后 90 天的住院再入院率为 20%至 40%。
本研究旨在开发和验证一种简单的评分系统，以预测 CRS/HIPEC 后的再入院率。
使用前瞻性维护的数据库，我们回顾性地审查了 2010 年至 2018 年间接受腹膜表面恶性肿瘤 CRS/HIPEC 的患者的临床病理、围手术期和出院当天的数据。排除院内死亡率和临终关怀出院。利用多元逻辑回归来确定非计划性再入院的预测因素，将样本的四分之三随机选择为推导队列，四分之一为验证队列。使用基于回归系数的评分方法，我们开发了一种加权的 7 因素、10 分预测评分，用于预测再入院风险。
共分析了 1068 例合格出院患者；379 例患者在 90 天内再次入院（35.5%）。有 7 个因素与再入院相关：造口术、腹膜癌指数评分≥15、低钠血症、院内主要并发症、术前化疗、贫血和疗养院出院。在验证队列中，25 例（9.2%）患者被归类为再入院的高风险患者，预测再入院率为 69.3%，实际再入院率为 76.0%。该评分具有较好的区分度（曲线下面积 0.70）和良好的校准度（Hosmer-Lemeshow 拟合优度检验 p 值为 0.77）。
我们提出的风险评分在 CRS/HIPEC 后 90 天内很容易在出院当天获得，可以区分高风险再入院患者。该评分有可能针对高危人群进行强化随访和其他干预措施。
