多机构择期憩室炎手术队列研究：国家手术质量改进计划数据库分析，以确定老年人非家庭出院的预测因素。

Multi-institutional Cohort Study of Elective Diverticulitis Surgery: a National Surgical Quality Improvement Program Database Analysis to Identify Predictors of Non-home Discharge Among Older Adults.

机构信息

Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman St., WACC 460, Boston, MA, 02114, USA.

Ariadne Labs, Brigham and Women's Hospital, Harvard. T.H. School of Public Health, Boston, MA, USA.

出版信息

J Gastrointest Surg. 2022 Sep;26(9):1899-1908. doi: 10.1007/s11605-022-05335-8. Epub 2022 May 6.

DOI:10.1007/s11605-022-05335-8

PMID:35524079

Abstract

BACKGROUND

Older adults often prioritize independence and time spent at home when making major treatment decisions. Identifying preoperative predictors of non-home discharge (i.e., requiring institutional discharge rather than home), among adults undergoing elective diverticulitis surgery, can support surgical decision-making and expectation management. This study aims to (1) examine rates of non-home discharge after elective surgery for diverticulitis and (2) identify predictors of non-home discharge.

METHODS

This is a multi-institutional cohort study of National Surgical Quality Improvement Program Database. Patients over 18 years who underwent colon resection with diagnosis of diverticulitis were included. Clinical and demographic information were collected by trained nurse reviewers. Emergency operations were excluded. Patients with home versus non-home discharge were compared and predictors identified using multivariable regression.

RESULTS

Between 2016 and 2019, 40,912 patients were identified. Mean age was 58.5 years (SD = 12.58) with 48.5% 60 + years and 17.7% of patients 70 + years old. The majority (55.9%) were female and "White" race (83.5%). Most patients underwent colectomy without ostomy (88.4%). Nine percent of patients over age 60 had non-home discharge. Functional dependence preoperatively was strongly associated with non-home discharge. On multivariable analysis, significant predictors of non-home discharge were preoperative functional dependence (OR 28.2; 95% CI 9.8-81.7), advancing chronologic age (age 80 + : OR 22.4; 95% CI 18.6-26.9), and preoperative albumin < 3.0 (OR 4.0; 95% CI 3.4-4.6).

CONCLUSIONS

Nearly one in ten patients over 60 years was not discharged home after elective diverticulitis surgery. Preoperative functional status predicts non-home discharge. Future studies need to assess potentially modifiable causes of non-home discharge, such as social support.

摘要

背景

老年人在做出重大治疗决策时，通常会优先考虑独立和在家中的时间。在接受择期憩室炎手术的成年人中，确定非家庭出院（即需要机构出院而不是家庭出院）的术前预测因素，可以支持手术决策和预期管理。本研究旨在：（1）检查择期憩室炎手术后非家庭出院的发生率；（2）确定非家庭出院的预测因素。

方法

这是国家手术质量改进计划数据库的多机构队列研究。纳入年龄在 18 岁以上、接受结肠切除术且诊断为憩室炎的患者。临床和人口统计学信息由经过培训的护士审查员收集。排除急诊手术。比较家庭与非家庭出院患者，并使用多变量回归确定预测因素。

结果

在 2016 年至 2019 年间，共确定了 40912 名患者。平均年龄为 58.5 岁（标准差=12.58），60 岁以上者占 48.5%，70 岁以上者占 17.7%。大多数（55.9%）为女性，种族为“白人”（83.5%）。大多数患者接受了无造口的结肠切除术（88.4%）。超过 60 岁的患者中有 9%是非家庭出院。术前功能依赖与非家庭出院密切相关。多变量分析显示，非家庭出院的显著预测因素包括术前功能依赖（OR 28.2；95%CI 9.8-81.7）、年龄增长（80 岁以上：OR 22.4；95%CI 18.6-26.9）和术前白蛋白<3.0（OR 4.0；95%CI 3.4-4.6）。