Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Urol Oncol. 2023 Sep;41(9):392.e19-392.e25. doi: 10.1016/j.urolonc.2023.07.003. Epub 2023 Jul 25.
To identify patient risk factors that predict nonhome discharge after surgery for urologic malignancies as well as determine whether discharge status had an impact on readmission rates in patients undergoing surgery for urologic malignancies.
We identified patients who had undergone surgery for urologic malignancies including prostate, bladder, kidney, or upper tract urothelial cancer from 2011 to 2019 in the American College of Surgeon National Surgical Quality Improvement Program (ACS-NSQIP) database. Multivariable logistic regression analyses were performed to identify patient characteristics that were associated with nonhome discharges and 30-day postoperative readmission.
Nonhome discharge occurred in 2.8% of our study population. Women were less likely to be discharged to home (OR 0.60 p < 0.0001). Nonhome discharge was more common in patients who underwent cystectomy when compared to nephrectomy (OR 1.41 p < 0.0001) or prostatectomy (OR 4.16 p < 0.0001). Those with elevated BMI were less likely to experience non-home discharge (OR 0.86 p=0.0095) while patients who were identified as underweight and those with unexpected weight loss prior to surgery were more likely to have nonhome discharges (OR 1.76 p = 0.0002, OR 1.67, p < 0.0001). Comorbidities and presence of postoperative complications were also found to be significant independent predictors of nonhome discharges. Thirty-day postoperative readmission occurred in 6.9% of our study population. Of the patients who were readmitted 93.1% were initially discharged home, and 6.9% had nonhome discharges. Higher risk of readmission was seen in elderly patients and those with significant comorbidities. When controlling for predictors of readmission, on multivariate analysis, non-home discharge was associated with a decreased likelihood of readmission (OR 0.79, p = 0.0004).
Patient factors including age, gender, weight, comorbidities, postoperative complications, and site of procedure were found to be independent predictors of non-home discharge following surgery for urologic malignancies. Patients with these risk factors should be counseled preoperatively on the likelihood of requiring a non-home discharge to help manage expectations and create a standardized transition of care pathway following surgery.
确定预测泌尿外科恶性肿瘤手术后非家庭出院的患者风险因素，并确定出院状态是否会影响泌尿外科恶性肿瘤手术患者的再入院率。
我们在美国外科医师学院国家外科质量改进计划（ACS-NSQIP）数据库中确定了 2011 年至 2019 年间接受过泌尿外科恶性肿瘤（包括前列腺、膀胱、肾脏或上尿路尿路上皮癌）手术的患者。进行多变量逻辑回归分析，以确定与非家庭出院和 30 天术后再入院相关的患者特征。
在我们的研究人群中，非家庭出院发生率为 2.8%。与接受肾切除术或前列腺切除术相比，女性更不可能被送回家（OR 0.60，p<0.0001）。与接受肾切除术相比，接受膀胱切除术的患者更有可能非家庭出院（OR 1.41，p<0.0001）或前列腺切除术（OR 4.16，p<0.0001）。BMI 升高的患者不太可能经历非家庭出院（OR 0.86，p=0.0095），而体重不足和术前意外体重减轻的患者更有可能非家庭出院（OR 1.76，p=0.0002，OR 1.67，p<0.0001）。合并症和术后并发症的存在也被发现是非家庭出院的独立显著预测因素。我们的研究人群中有 6.9%的患者发生了 30 天术后再入院。在再入院的患者中，93.1%最初被送回家，6.9%非家庭出院。年龄较大的患者和合并症较多的患者再入院风险较高。在控制再入院的预测因素后，多变量分析显示，非家庭出院与再入院的可能性降低相关（OR 0.79，p=0.0004）。
包括年龄、性别、体重、合并症、术后并发症和手术部位在内的患者因素被发现是泌尿外科恶性肿瘤手术后非家庭出院的独立预测因素。对于这些有风险的患者，应在术前对他们进行非家庭出院的可能性进行咨询，以帮助管理期望并建立术后标准化的过渡护理途径。
