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肺手术后严重和轻微并发症对住院时间和再入院的影响。

The Effect of Major and Minor Complications After Lung Surgery on Length of Stay and Readmission.

作者信息

Finley Christian J, Begum Housne A, Pearce Kendra, Agzarian John, Hanna Waël C, Shargall Yaron, Akhtar-Danesh Noori

机构信息

Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada.

School of Nursing, McMaster University, Hamilton, Ontario, Canada.

出版信息

J Patient Exp. 2022 Feb 1;9:23743735221077524. doi: 10.1177/23743735221077524. eCollection 2022.

Abstract

The effect of post-operative adverse events (AEs) on patient outcomes such as length of stay (LOS) and readmissions to hospital is not completely understood. This study examined the severity of AEs from a high-volume thoracic surgery center and its effect on the patient postoperative LOS and readmissions to hospital. This study includes patients who underwent an elective lung resection between September 2018 and January 2020. The AEs were grouped as no AEs, 1 or more minor AEs, and 1 or more major AEs. The effects of the AEs on patient LOS and readmissions were examined using a survival analysis and logistic regression, respectively, while adjusting for the other demographic or clinical variables. Among 488 patients who underwent lung surgery, (Wedge resection [n = 100], Segmentectomy [n = 51], Lobectomy [n = 310], Bilobectomy [n = 10], or Pneumonectomy [n = 17]) for either primary (n = 440) or secondary (n = 48) lung cancers, 179 (36.7%) patients had no AEs, 264 (54.1%) patients had 1 or more minor AEs, and 45 (9.2%) patients had 1 or more major AEs. Overall, the median of LOS was 3 days which varied significantly between AE groups; 2, 4, and 8 days among the no, minor, and major AE groups, respectively. In addition, type of surgery, renal disease (urinary tract infection [UTI], urinary retention, or acute kidney injury), and ASA (American Society of Anesthesiology) score were significant predictors of LOS. Finally, 58 (11.9%) patients were readmitted. Readmission was significantly associated with AE group ( = 0.016). No other variable could significantly predict patient readmission. Overall, postoperative AEs significantly affect the postoperative LOS and readmission rates.

摘要

术后不良事件(AE)对住院时间(LOS)和再次入院等患者预后的影响尚未完全明确。本研究调查了一家大型胸外科中心AE的严重程度及其对患者术后LOS和再次入院的影响。本研究纳入了2018年9月至2020年1月期间接受择期肺切除术的患者。AE被分为无AE、1次或更多次轻微AE以及1次或更多次严重AE。在调整其他人口统计学或临床变量的同时,分别使用生存分析和逻辑回归研究AE对患者LOS和再次入院的影响。在488例接受肺手术的患者中(楔形切除术[n = 100]、肺段切除术[n = 51]、肺叶切除术[n = 310]、双肺叶切除术[n = 10]或全肺切除术[n = 17]),用于原发性(n = 440)或继发性(n = 48)肺癌,179例(36.7%)患者无AE,264例(54.1%)患者有1次或更多次轻微AE,45例(9.2%)患者有1次或更多次严重AE。总体而言,LOS的中位数为3天,在AE组之间有显著差异;无、轻微和严重AE组分别为2天、4天和8天。此外,手术类型、肾脏疾病(尿路感染[UTI]、尿潴留或急性肾损伤)和ASA(美国麻醉医师协会)评分是LOS的显著预测因素。最后,58例(11.9%)患者再次入院。再次入院与AE组显著相关(P = 0.016)。没有其他变量能显著预测患者再次入院。总体而言,术后AE显著影响术后LOS和再次入院率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27ea/8811790/c9fa7588907f/10.1177_23743735221077524-fig1.jpg

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