Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Division of Urogynecology and Pelvic Floor Disorders, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Neurourol Urodyn. 2022 Apr;41(4):1031-1040. doi: 10.1002/nau.24924. Epub 2022 Mar 29.
This study aimed to determine factors associated with prolonged hospital admission following outpatient female pelvic reconstructive surgery (FPRS) and associated adverse clinical outcomes.
Using the National Surgical Quality Improvement Program database, we identified outpatient FPRS performed 2011-2016. Isolated hysterectomy without concurrent prolapse repair was excluded. Surgeries were classified as major or minor for analysis. The primary outcome was prolonged length of stay (LOS), defined as admission of ≥2 days. Secondary outcomes included complications, readmission and reoperation associated with prolonged LOS. We abstracted data on covariates, and following univariable analysis, performed backward stepwise regression analysis.
A total of 29645 women were included: 12311 (41.5%) major and 17334 (58.5%) minor procedures. A total of 6.9% (2033) had a prolonged LOS. On full cohort multivariable regression analysis, patient characteristics associated with prolonged LOS were older age (odds ratio [OR]: 1.1 per 10 years, confidence interval [CI]: 1.06-1.1, p < 0.001), frailty (OR: 1.8, 95% CI: 1.3-2.6, p = 0.001), and Caucasian race (OR: 1.2, CI: 1.02-1.3, p = 0.024). Associated surgical factors included having a major surgical procedure (OR: 1.3, CI: 1.2-1.4, p < 0.001), use of general anesthesia (OR: 2.0, CI: 1.5-2.6, p < 0.001) and longer operative time (OR: 2.0, CI: 1.8-2.2, p < 0.001). The occurrence of any complication (10.3% vs. 4.7%, p < 0.001), hospital readmission (4.3% vs. 1.7%, p < 0.001), and reoperation (2.7% vs. 1.0%, p < 0.001) were more likely with prolonged LOS.
After outpatient FPRS, 6.9% of patients experience an admission of ≥2 days. Prolonged LOS is more common in patients who are older, frail and Caucasian, and in those who have major surgery with long operative time and general anesthesia.
本研究旨在确定与门诊女性盆底重建手术（FPRS）后住院时间延长相关的因素，并探讨其与不良临床结局的关系。
我们使用国家手术质量改进计划数据库，纳入了 2011 年至 2016 年期间进行的门诊 FPRS 患者。排除了单纯的子宫切除术而无同期脱垂修复术的患者。手术分为主要手术和次要手术进行分析。主要结局为住院时间延长（LOS），定义为住院时间≥2 天。次要结局包括与 LOS 延长相关的并发症、再入院和再次手术。我们提取了协变量数据，在单变量分析后，进行了向后逐步回归分析。
共纳入 29645 名女性患者：12311 名（41.5%）为主要手术，17334 名（58.5%）为次要手术。共有 6.9%（2033 名）患者的 LOS 延长。在全队列多变量回归分析中，与 LOS 延长相关的患者特征包括年龄较大（每增加 10 岁，比值比 [OR]：1.1，95%置信区间 [CI]：1.06-1.1，p<0.001）、衰弱（OR：1.8，95%CI：1.3-2.6，p=0.001）和白种人（OR：1.2，CI：1.02-1.3，p=0.024）。相关手术因素包括主要手术（OR：1.3，CI：1.2-1.4，p<0.001）、全身麻醉（OR：2.0，CI：1.5-2.6，p<0.001）和较长的手术时间（OR：2.0，CI：1.8-2.2，p<0.001）。任何并发症的发生率（10.3%比 4.7%，p<0.001）、医院再入院率（4.3%比 1.7%，p<0.001）和再次手术率（2.7%比 1.0%，p<0.001）在 LOS 延长的患者中更为常见。
在门诊 FPRS 后，6.9%的患者住院时间≥2 天。年龄较大、衰弱和白种人、手术较大、手术时间较长和全身麻醉的患者更可能出现 LOS 延长。
