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机器人辅助肝切除术治疗肿瘤性疾病后的医院再入院:危险因素、生存和经济影响的分析。逻辑回归和倾向评分匹配研究。

Hospital readmissions after robotic hepatectomy for neoplastic disease: Analysis of risk factors, survival, and economical impact. A logistical regression and propensity score matched study.

机构信息

Florida Atlantic University Schmidt College of Medicine, USA; Digestive Health Institute AdventHealth Tampa, USA.

Digestive Health Institute AdventHealth Tampa, USA.

出版信息

Am J Surg. 2024 Aug;234:92-98. doi: 10.1016/j.amjsurg.2024.03.014. Epub 2024 Mar 18.

Abstract

BACKGROUND

As the first comprehensive investigation into hospital readmissions following robotic hepatectomy for neoplastic disease, this study aims to fill a critical knowledge gap by evaluating risk factors associated with readmission and their impact on survival and the financial burden.

METHODS

The study analyzed a database of robotic hepatectomy patients, comparing readmitted and non-readmitted individuals post-operatively using 1:1 propensity score matching. Statistical methods included Chi-square, Mann-Whitney U, T-test, binomial logistic regression, and Kaplan-Meier analysis.

RESULTS

Among 244 patients, 44 were readmitted within 90 days. Risk factors included hypertension (p ​= ​0.01), increased Child-Pugh score (p ​< ​0.01), and R1 margin status (p ​= ​0.05). Neoadjuvant chemotherapy correlated with lower readmission risk (p ​= ​0.045). Readmissions didn't significantly impact five-year survival (p ​= ​0.42) but increased fixed indirect hospital costs (p ​< ​0.01).

CONCLUSIONS

Readmission post-robotic hepatectomy correlates with hypertension, higher Child-Pugh scores, and R1 margins. The use of neoadjuvant chemotherapy was associated with a lower admission rate due to less diffuse liver disease in these patients. While not affecting survival, readmissions elevate healthcare costs.

摘要

背景

作为首次针对肿瘤性疾病行机器人肝切除术后住院再入院情况的全面调查,本研究旨在通过评估与再入院相关的风险因素及其对生存和经济负担的影响,填补这一关键知识空白。

方法

本研究分析了机器人肝切除术患者的数据库,通过 1:1 倾向评分匹配比较术后再入院和非再入院个体。统计方法包括卡方检验、Mann-Whitney U 检验、T 检验、二项逻辑回归和 Kaplan-Meier 分析。

结果

在 244 例患者中,44 例在 90 天内再入院。风险因素包括高血压(p=0.01)、Child-Pugh 评分增加(p<0.01)和 R1 切缘状态(p=0.05)。新辅助化疗与较低的再入院风险相关(p=0.045)。再入院并未显著影响五年生存率(p=0.42),但增加了固定的间接医院费用(p<0.01)。

结论

机器人肝切除术后再入院与高血压、较高的 Child-Pugh 评分和 R1 切缘相关。新辅助化疗的使用与较低的入院率相关,这是由于这些患者的肝脏疾病扩散程度较轻。尽管再入院不影响生存率,但会增加医疗保健成本。

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