Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH. Electronic address: https://twitter.com/timpawlik.
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH.
Surgery. 2022 Apr;171(4):1043-1050. doi: 10.1016/j.surg.2021.08.030. Epub 2021 Sep 15.
Regionalization of hepatopancreatic surgery to high-volume hospitals has been associated with fragmentation of postoperative care and, in turn, inferior outcomes after surgery. The objective of this study was to examine the association of social vulnerability with the likelihood of experiencing fragmentation of postoperative care (FPC) after hepatopancreatic surgery.
Patients who underwent hepatopancreatic surgery and had at least 1 readmission within 90 days were identified using Medicare 100% Standard Analytical Files between 2013 and 2017. Fragmentation of postoperative care was defined as readmission at a hospital other than the index institution where the initial surgery was performed. The association of social vulnerability index and its components with fragmentation of postoperative care was examined.
Among 11,142 patients, 8,053 (72.3%) underwent pancreatectomy, and 3,089 (27.7%) underwent hepatectomy. The overall incidence of fragmentation of postoperative care was 32.9% (n = 3,667). Patients who experienced fragmentation of postoperative care were older (73 years [interquartile range: 69-77] vs 72 years [interquartile range: 68-77]) and had a higher Charlson comorbidity score (4 [interquartile range: 2-8] vs 3 [interquartile range: 2-8]) (both P < .001). Median overall social vulnerability index was higher among patients who experienced fragmentation of postoperative care (52.5 [interquartile range: 29.3-70.4] vs 51.3 [interquartile range: 27.9-69.4], P = .02). On multivariable analysis, the odds of experiencing fragmentation of postoperative care was higher with increasing overall social vulnerability index (odds ratio: 1.14; 95% confidence interval 1.01-1.30). Additionally, the odds of experiencing fragmentation of postoperative care were higher among patients with high vulnerability owing to their socioeconomic status (odds ratio: 1.28; 95% confidence interval 1.12-1.45) or their household composition and disability (odds ratio: 1.35; 95% confidence interval 1.19-1.54), whereas high vulnerability owing to minority status and language was inversely associated with fragmentation of postoperative care (odds ratio: 0.73; 95% confidence interval 0.64-0.84).
Social vulnerability was strongly associated with the odds of experiencing fragmented postoperative care after hepatopancreatic surgery.
将肝胰手术区域化到高容量医院与术后护理的碎片化有关，进而导致手术后的结果恶化。本研究的目的是研究社会脆弱性与肝胰手术后经历术后护理碎片化（FPC）的可能性之间的关联。
使用 2013 年至 2017 年期间 Medicare 100%标准分析文件，确定了至少在 90 天内有 1 次再入院的接受肝胰手术的患者。术后护理碎片化定义为在初始手术进行的索引机构以外的医院再次入院。检查社会脆弱性指数及其组成部分与术后护理碎片化之间的关联。
在 11142 名患者中，8053 名（72.3%）接受了胰切除术，3089 名（27.7%）接受了肝切除术。总体术后护理碎片化发生率为 32.9%（n=3667）。经历术后护理碎片化的患者年龄较大（73 岁[四分位距：69-77]与 72 岁[四分位距：68-77]），Charlson 合并症评分较高（4[四分位距：2-8]与 3[四分位距：2-8]）（均 P<0.001）。经历术后护理碎片化的患者的总体社会脆弱性指数中位数较高（52.5[四分位距：29.3-70.4]与 51.3[四分位距：27.9-69.4]，P=0.02）。在多变量分析中，随着整体社会脆弱性指数的增加，经历术后护理碎片化的可能性更高（比值比：1.14；95%置信区间 1.01-1.30）。此外，由于社会经济地位（比值比：1.28；95%置信区间 1.12-1.45）或家庭组成和残疾（比值比：1.35；95%置信区间 1.19-1.54）而导致的高脆弱性患者发生术后护理碎片化的可能性更高，而由于少数民族地位和语言而导致的高脆弱性与术后护理碎片化呈负相关（比值比：0.73；95%置信区间 0.64-0.84）。
社会脆弱性与肝胰手术后经历碎片化术后护理的可能性密切相关。
