Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Neurosurgery. 2022 Sep 1;91(3):477-484. doi: 10.1227/neu.0000000000002063. Epub 2022 Jul 14.
BACKGROUND: Postoperative 30-day readmissions have been shown to negatively affect survival and other important outcomes in patients with glioblastoma (GBM). OBJECTIVE: To further investigate patient readmission risk factors of primary and recurrent patients with GBM. METHODS: The authors retrospectively reviewed records of 418 adult patients undergoing 575 craniotomies for histologically confirmed GBM at an academic medical center. Patient demographics, comorbidities, and clinical characteristics were collected and compared by patient readmission status using chi-square and Mann-Whitney U testing. Multivariable logistic regression was performed to identify risk factors that predicted 30-day readmissions. RESULTS: The cohort included 69 (12%) 30-day readmissions after 575 operations. Readmitted patients experienced significantly lower median overall survival (11.3 vs 16.4 months, P = .014), had a lower mean Karnofsky Performance Scale score (66.9 vs 74.2, P = .005), and had a longer initial length of stay (6.1 vs 5.3 days, P = .007) relative to their nonreadmitted counterparts. Readmitted patients experienced more postoperative deep vein thromboses or pulmonary embolisms (12% vs 4%, P = .006), new motor deficits (29% vs 14%, P = .002), and nonhome discharges (39% vs 22%, P = .005) relative to their nonreadmitted counterparts. Multivariable analysis demonstrated increased odds of 30-day readmission with each 10-point decrease in Karnofsky Performance Scale score (odds ratio [OR] 1.32, P = .002), each single-point increase in 5-factor modified frailty index (OR 1.51, P = .016), and initial presentation with cognitive deficits (OR 2.11, P = .013). CONCLUSION: Preoperatively available clinical characteristics strongly predicted 30-day readmissions in patients undergoing surgery for GBM. Opportunities may exist to optimize preoperative and postoperative management of at-risk patients with GBM, with downstream improvements in clinical outcomes.
背景:术后 30 天再入院已被证明会对胶质母细胞瘤(GBM)患者的生存和其他重要结局产生负面影响。 目的:进一步探讨原发性和复发性 GBM 患者再入院的风险因素。 方法:作者回顾性分析了在一家学术医疗中心接受 575 例经组织学证实的 GBM 开颅手术的 418 例成年患者的记录。使用卡方检验和曼-惠特尼 U 检验比较患者再入院状态的患者人口统计学、合并症和临床特征。采用多变量逻辑回归分析确定预测 30 天再入院的危险因素。 结果:该队列包括 575 例手术中 69 例(12%)术后 30 天再入院。与未再入院的患者相比,再入院患者的中位总生存期明显缩短(11.3 个月比 16.4 个月,P =.014),卡诺夫斯基表现量表评分均值较低(66.9 比 74.2,P =.005),初始住院时间较长(6.1 天比 5.3 天,P =.007)。与未再入院的患者相比,再入院患者术后发生深静脉血栓或肺栓塞的比例更高(12%比 4%,P =.006),新出现运动障碍的比例更高(29%比 14%,P =.002),非家庭出院的比例更高(39%比 22%,P =.005)。多变量分析显示,卡诺夫斯基表现量表评分每降低 10 分,30 天再入院的几率增加 1.32 倍(比值比 [OR] 1.32,P =.002),5 因素改良脆弱指数每增加 1 分,30 天再入院的几率增加 1.51 倍(OR 1.51,P =.016),初始表现为认知障碍的几率增加 2.11 倍(OR 2.11,P =.013)。 结论:术前可获得的临床特征强烈预测了接受 GBM 手术的患者 30 天再入院的情况。可能有机会优化高危 GBM 患者的术前和术后管理,从而改善临床结局。
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