肌肉减少症和低营养状态与胃癌根治术后计划性再入院的相关性：一项病例对照研究。

Association of Sarcopenia and Low Nutritional Status with Unplanned Hospital Readmission after Radical Gastrectomy in Patients with Gastric Cancer: A Case-Control Study.

机构信息

Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

First Clinical College of Wenzhou Medical University, Wenzhou, China.

出版信息

J Healthc Eng. 2022 Apr 15;2022:7246848. doi: 10.1155/2022/7246848. eCollection 2022.

DOI:10.1155/2022/7246848

PMID:35463676

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9033374/

Abstract

OBJECTIVE

Sarcopenia is one of the influencing factors of poor prognosis in patients with gastric cancer but the association with readmission are unknown. We aimed to explore factors associated with readmission after gastrectomy and to determine whether preoperative sarcopenia is a common outcome in readmitted patients.

METHODS

In this case-control study, patients who underwent gastric resection in the First Affiliated Hospital of Wenzhou Medical University between April 2016 and September 2017 were included. The reasons of readmission patients were described. The readmission patients and non-readmission patients were matched by propensity score matching (PSM). The univariate analysis was applied for the baseline characteristics, operative details, postoperative prognosis and discharge disposition, and multiple logistic regression analysis for the independent risk factors of readmission.

RESULTS

The unplanned readmission rate within 30 days of radical gastrectomy for gastric cancer was 6.5% (43/657). The average time interval from discharge to readmission was 13 days. Delayed gastric evacuation was the main cause of readmission (18.6%, 8/43). Body mass index (BMI), nutritional risk screening (NRS) 2002 score, history of abdominal surgery, sarcopenia, and preoperative albumin were included in the multivariate logistic regression analysis. NRS 2002 (OR = 3.43, 95% CI: 1.10-10.72, =0.034) and sarcopenia (OR = 4.25, 95% CI: 1.13-16.02, =0.033) were found to be independently associated with unplanned readmission within 30 days of radical gastrectomy for cancer. Other factors such as age, sex, BMI, American Society of Anesthesiologists grade, surgical method, operation and reconstruction type, TNM stage, surgical duration, previous abdominal surgery, and preoperative albumin and hemoglobin level were not associated with unplanned readmission after radical gastrectomy for cancer.

CONCLUSIONS

Sarcopenia and low nutritional status are independently associated with unplanned readmission within 30 days of radical gastrectomy for cancer.

摘要

目的

肌少症是影响胃癌患者预后不良的因素之一，但与再入院的关系尚不清楚。本研究旨在探讨胃切除术后再入院的相关因素，并确定术前肌少症是否是再入院患者的常见结局。

方法

本病例对照研究纳入了 2016 年 4 月至 2017 年 9 月在温州医科大学第一附属医院行胃切除术的患者。描述了再入院患者的原因。通过倾向评分匹配（PSM）将再入院患者和非再入院患者进行匹配。采用单因素分析比较基线特征、手术细节、术后预后和出院情况，采用多因素 logistic 回归分析再入院的独立危险因素。

结果

胃癌根治性胃切除术后 30 天内计划性再入院率为 6.5%（43/657）。从出院到再入院的平均时间间隔为 13 天。胃排空延迟是再入院的主要原因（18.6%，8/43）。体质量指数（BMI）、营养风险筛查 2002 评分（NRS 2002）、腹部手术史、肌少症和术前白蛋白均纳入多因素 logistic 回归分析。NRS 2002（OR=3.43，95%CI：1.10-10.72，=0.034）和肌少症（OR=4.25，95%CI：1.13-16.02，=0.033）与癌症根治性胃切除术后 30 天内计划外再入院独立相关。其他因素，如年龄、性别、BMI、美国麻醉医师协会分级、手术方法、手术和重建类型、TNM 分期、手术时间、既往腹部手术以及术前白蛋白和血红蛋白水平与癌症根治性胃切除术后计划外再入院无关。