卵巢癌择期手术后急诊再入院的相关因素。
Factors associated with emergency room readmission after elective surgery for ovarian carcinoma.
机构信息
Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud. UNAM, Mexico City, Mexico.
Departamento de Ginecología, Instituto Nacional de Cancerología, Mexico City, Mexico.
出版信息
BMC Womens Health. 2023 Sep 4;23(1):473. doi: 10.1186/s12905-023-02579-7.
BACKGROUND
Hospital readmission is a quality metric of hospital care and has been studied in ovarian carcinoma, but its evaluation has several limitations. Also, emergency room (ER) readmission is considered an adverse effect because it represents patient costs. Therefore, our objective was to determine the rate of ER readmission, its causes, and associated factors.
METHODS
A retrospective study of 592 patients with ovarian carcinoma who underwent upfront surgery, neoadjuvant therapy, or surgery for recurrent disease. An analysis of factors associated with ER readmission, hospital readmission, and surgical complications was performed, including multivariate analysis to assess for case-mix factors.
RESULTS
Of 592 patients, the median age was 51 years, and the predominant type of treatment was the neoadjuvant approach (52.9%); 46% underwent upfront surgeries and six surgeries for recurrence. The ratio to ER readmission was 11.8% (70 patients), of whom 12 patients were admitted more than once. The factors associated with ER readmission were prolonged surgery, intraoperative bleeding, extended hospital stay, the time of the day when the surgery was performed, and post-surgical complications. The hospital readmissions were 4.2%, and the overall morbidity was 17.6%. In the multivariate analysis, the only factor associated with ER readmission was the presence of surgical complications (OR = 39.01). The factors independently associated with hospital readmission were the entrance to the intensive care unit (OR = 1.37), the presence of surgical complications (OR = 2.85), and ER readmission (OR = 1.45).
CONCLUSION
ER readmission is an adverse event representing the presence of symptoms/complications in patients. Evaluating the ER readmission independently of the readmission to the hospital is critical because it will allow modifying medical care behaviors to prevent patients from unnecessarily returning to the hospital after a hospital discharge to manage preventable medical problems.
TRIAL REGISTRATION
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背景
医院再入院是医院护理质量的一项指标，已在卵巢癌中进行了研究，但它的评估有几个局限性。此外，急诊（ER）再入院被认为是一种不良后果，因为它代表了患者的成本。因此，我们的目的是确定 ER 再入院率、其原因和相关因素。
方法
对 592 例接受初次手术、新辅助治疗或复发性疾病手术的卵巢癌患者进行回顾性研究。对与 ER 再入院、医院再入院和手术并发症相关的因素进行分析，包括多变量分析以评估病例组合因素。
结果
在 592 例患者中，中位年龄为 51 岁，主要治疗类型为新辅助方法（52.9%）；46%的患者接受了初次手术，6 例为复发性手术。ER 再入院率为 11.8%（70 例），其中 12 例患者入院超过一次。与 ER 再入院相关的因素包括手术时间延长、术中出血、住院时间延长、手术时间和术后并发症。医院再入院率为 4.2%，总发病率为 17.6%。在多变量分析中，唯一与 ER 再入院相关的因素是存在手术并发症（OR=39.01）。与医院再入院独立相关的因素包括进入重症监护病房（OR=1.37）、存在手术并发症（OR=2.85）和 ER 再入院（OR=1.45）。
结论
ER 再入院是一种不良事件，代表患者存在症状/并发症。独立评估 ER 再入院与医院再入院非常重要，因为它可以改变医疗保健行为，以防止患者在出院后因管理可预防的医疗问题而不必要地返回医院。
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