Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
Eur J Cardiothorac Surg. 2022 Aug 3;62(3). doi: 10.1093/ejcts/ezac385.
The purpose of this study was to describe the incidence of and reasons for early (0-30 days) and late (31-90 days) readmissions after enhanced recovery video-assisted thoracoscopic surgery lobectomy.
We performed a retrospective analysis of prospectively collected consecutive VATS lobectomy data in an institutional database from January 2019 through December 2020. All reasons for readmission with complete follow-up were individually evaluated. Univariable and multivariable analyses were used to assess predictors.
In total, 508 patients were included; the median length of stay after the operation was 3 days. There were 77 (15%) early and 54 (11%) late readmissions, respectively. There were 33 (7%) multiple readmissions during postoperative days 0-90 ; pneumonia (19.8%) and pneumothorax (18.3%) were the dominant reasons for early readmissions, and the side effects of adjuvant chemotherapy (22.0%), for late readmissions. In multivariable analyses, current smoking (P = 0.001), alcohol abuse (P = 0.024) and chronic obstructive pulmonary disease (P = 0.019) were predictors of early readmissions, whereas Clavien-Dindo I-II grade gastrointestinal complications predicted late readmissions (P = 0.006) and multiple readmissions (P = 0.007). Early discharge (< 3 days) was not a predictor of readmissions. Early readmission did not increase late readmission.
Early and late readmissions after video-assisted thoracoscopic lobectomy are frequent even when enhanced recovery programmes are followed. Pulmonary complications and adjuvant chemotherapy are the most predominant reasons for early and late readmissions.
本研究旨在描述接受加速康复视频辅助胸腔镜肺叶切除术后早期（0-30 天）和晚期（31-90 天）再入院的发生率和原因。
我们对 2019 年 1 月至 2020 年 12 月期间机构数据库中连续前瞻性收集的 VATS 肺叶切除术数据进行了回顾性分析。单独评估了每一次再入院的原因，并进行了单变量和多变量分析以评估预测因素。
共纳入 508 例患者，术后中位住院时间为 3 天。分别有 77 例（15%）和 54 例（11%）发生早期和晚期再入院。术后 0-90 天内有 33 例（7%）多次再入院，主要的早期再入院原因是肺炎（19.8%）和气胸（18.3%），晚期再入院的主要原因是辅助化疗的副作用（22.0%）。多变量分析显示，当前吸烟（P=0.001）、酗酒（P=0.024）和慢性阻塞性肺疾病（P=0.019）是早期再入院的预测因素，而 Clavien-Dindo I-II 级胃肠道并发症则预测晚期再入院（P=0.006）和多次再入院（P=0.007）。早期出院（<3 天）不是再入院的预测因素。早期再入院不会增加晚期再入院。
即使采用加速康复方案，接受电视辅助胸腔镜肺叶切除术后仍会频繁发生早期和晚期再入院。肺部并发症和辅助化疗是早期和晚期再入院的最主要原因。
