患者在加速康复胸腔镜楔形切除术（enhanced recovery thoracoscopic wedge resection）后为何仍住院？一项前瞻性观察研究。

Why do patients stay in hospital after enhanced recovery thoracoscopic wedge resection? A prospective observational study.

机构信息

Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

出版信息

Eur J Cardiothorac Surg. 2024 Oct 1;66(4). doi: 10.1093/ejcts/ezae366.

DOI:10.1093/ejcts/ezae366

PMID:39374548

Abstract

OBJECTIVES

This single-centre prospective observational study aimed to investigate reasons for prolonged hospitalization [over the median length of stay (LOS)] after enhanced recovery thoracoscopic [ERAS 3-port video-assisted thoracoscopic surgery (VATS)] wedge resection.

METHODS

All patients were evaluated twice-daily by an investigator for reasons of hospitalization. Each reason was analysed individually. Predictors for prolonged hospitalization were identified using a multivariable backward stepwise logistic regression model.

RESULTS

A total of 150 consecutive patients (lymphadenectomy 8.7%) were included from November 2022 to December 2023, with a median LOS of 1 (interquartile range 1-2) day. Of these, 55 patients (36.7%) experienced prolonged hospitalization. The main reasons included postoperative pain (16.0%), air leak (14.7%) and social factors (14.7%), followed by oxygen dependency (7.3%), gastrointestinal factors (5.3%), urinary factors (4.7%), pneumonia (1.3%), pleural effusion (1.3%), chylothorax (0.7%), atrial fibrillation (0.7%), confusion (0.7%) and fatigue (0.7%). Multivariable analysis revealed that an increase in the percentage of predicted forced expiratory volume in 1 s (FEV1%pre) by 1% [odds ratio (OR) 0.41, P = 0.023) and percentage of predicted diffusing capacity for carbon monoxide (DLCO%pre) by 1% (OR 0.95, P = 0.002) decreased likelihood of prolonged hospitalization. Conversely, each additional pack-year (OR 1.01, P = 0.028) and living alone (OR 3.55, P = 0.005) increased the risk of prolonged hospitalization.

CONCLUSIONS

Prolonged hospitalization (LOS > 1 day) after ERAS 3-port VATS wedge resection, with 8.7% lymphadenectomy, was mainly due to pain, air leak and social factors. Smokers with decreased FEV1%pre or DLCO%pre and patient living alone were at increased risk.

CLINICAL TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT06118593 (https://clinicaltrials.gov/study/NCT06118593?cond=why%20in%20hospital&rank=2).

摘要

目的

本单中心前瞻性观察研究旨在探讨微创胸腔镜肺楔形切除术（VATS）后住院时间延长（超过中位住院时间（LOS））的原因。

方法

由研究者每天两次对所有患者进行住院评估，分析每个原因。采用多变量向后逐步逻辑回归模型确定住院时间延长的预测因素。

结果

2022 年 11 月至 2023 年 12 月期间，共纳入 150 例连续患者（淋巴结清扫术 8.7%），中位 LOS 为 1 天（四分位间距 1-2 天）。其中，55 例（36.7%）患者住院时间延长。主要原因包括术后疼痛（16.0%）、气胸（14.7%）和社会因素（14.7%），其次是氧依赖（7.3%）、胃肠道因素（5.3%）、泌尿系统因素（4.7%）、肺炎（1.3%）、胸腔积液（1.3%）、乳糜胸（0.7%）、心房颤动（0.7%）、意识模糊（0.7%）和疲劳（0.7%）。多变量分析显示，用力肺活量占预计值的百分比（FEV1%pre）增加 1%（比值比（OR）0.41，P=0.023）和一氧化碳弥散量占预计值的百分比（DLCO%pre）增加 1%（OR 0.95，P=0.002），则延长住院时间的可能性降低。相反，每增加一个吸烟包年（OR 1.01，P=0.028）和独居（OR 3.55，P=0.005）会增加延长住院时间的风险。