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胃癌手术后30天内非计划再入院风险预测指标的最新系统评价与荟萃分析

Updated systematic review and meta‑analysis for risk predictors of 30‑day unplanned readmission following gastric cancer surgery.

作者信息

Li Jinquan, Hu Xiaosheng, Zhang Shanzhong

机构信息

Department of Gastrointestinal Surgery, The First People's Hospital of Jingdezhen, Jingdezhen, Jiangxi 33300, P.R. China.

出版信息

Oncol Lett. 2024 Aug 13;28(4):496. doi: 10.3892/ol.2024.14629. eCollection 2024 Oct.

Abstract

Readmission to hospital is a common occurrence due to adverse post-operative events. The primary objective of the present study was to examine the possible risk predictors for 30-day unplanned readmissions after the surgical treatment of gastric cancer. The secondary aim was to determine the clinical characteristics that are associated with readmission. Studies that reported the risk factors and clinical characteristics of patients with gastric cancer who had an unplanned 30-day post-operative readmission were identified systematically from PubMed, Cochrane Central Register of Controlled Trials, Web of Science and Embase databases, with a final search date of March 30, 2024. A systematic review and meta-analysis were then performed to estimate the risk predictors and relevant clinical characteristics for readmission. A total of 16,154 patients from 12 studies were included in the present study, with 1,736 patients who were readmitted and 14,418 patients who were not readmitted. A higher proportion of patients with an age ≥70 years, cardiovascular comorbidity, Nutritional Risk Screening (NRS) 2002 score ≥3, respiratory diseases, male sex, American Society of Anesthesiologists score ≥3, combined multi-organ resection, greater depth of invasion (T3-4/T1-2), discharge to home with provision of care services, neoadjuvant therapy, post-operative complications or a blood transfusion were found in the readmission group compared with that in the non-readmission group. A meta-analysis was also performed to calculate risk predictors using the results of multivariate regression analyses from the original literature. This identified cardiovascular comorbidity, NRS 2002 score ≥3, pancreatectomy and post-operative complications as risk predictors for 30-day unplanned readmission following surgery for gastric cancer. Therefore, it is recommended that extra attention and support should be given to patients with these high-risk predictors during the perioperative period.

摘要

由于术后不良事件,再次入院是一种常见现象。本研究的主要目的是检查胃癌手术治疗后30天内非计划再次入院的可能风险预测因素。次要目的是确定与再次入院相关的临床特征。从PubMed、Cochrane对照试验中心注册库、科学网和Embase数据库中系统地检索了报告胃癌患者术后30天非计划再次入院的风险因素和临床特征的研究,最终检索日期为2024年3月30日。然后进行了系统评价和荟萃分析,以估计再次入院的风险预测因素和相关临床特征。本研究共纳入了来自12项研究的16154例患者,其中1736例患者再次入院,14418例患者未再次入院。与未再次入院组相比,再次入院组中年龄≥70岁、有心血管合并症、营养风险筛查(NRS)2002评分≥3、有呼吸系统疾病、男性、美国麻醉医师协会评分≥3、联合多器官切除、浸润深度更深(T3 - 4/T1 - 2)、出院回家并提供护理服务、新辅助治疗、术后并发症或输血的患者比例更高。还进行了荟萃分析,使用原始文献中的多变量回归分析结果来计算风险预测因素。这确定心血管合并症、NRS 2002评分≥3、胰腺切除术和术后并发症是胃癌手术后30天非计划再次入院的风险预测因素。因此,建议在围手术期对具有这些高风险预测因素的患者给予额外关注和支持。

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