Bhamidipaty Madhu, Thillainadesan Janani, Rickard Matthew, Keshava Anil, Lam Vincent, Suen Michael
Department of Colorectal Surgery, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia.
Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
Int J Colorectal Dis. 2025 Apr 21;40(1):97. doi: 10.1007/s00384-025-04891-0.
This study aims to determine the rate of non-home discharge (NHD) and identify factors associated with non-home discharge in a colorectal cancer (CRC) population of adults aged 80 years and older. This is the first study looking specifically at NHD as an outcome in the ≥ 80 years colorectal cancer cohort.
This is a single-centre retrospective exploratory observational study from a high-volume colorectal cancer unit. Patients aged ≥ 80 years from a prospectively collected CRC database from 2013 to 2020 were included. Electronic medical records were assessed to obtain demographic, clinical, functional and discharge data. Univariable and multivariable logistic regression analyses were performed to identify factors associated with NHD the primary study outcome. Secondary outcomes included discharge disposition and functional decline.
Two hundred forty-two patients aged ≥ 80 years underwent CRC resection. Alo, 234 patients and 221 patients were included in the overall and subgroup non-home discharge analysis. The non-home discharge rate was 19.9% in the cohort that pre-operatively were from home. On multivariable logistic regression, after adjusting for other significant variables, frailty (odds ratio (OR) 2.91, 95% CI 1.25-6.75, p = 0.013), severe complications (OR 3.92, 95% CI 1.40-10.97, p = 0.009) and an open operation (OR 3.93, 95% CI 1.87-8.24, p < 0.001) were associated with a significantly higher rate of NHD. The incidence of functional decline from those at home was 72.4% in the non-home discharge group and 16.7% in those who returned home (p < 0.001).
This is the first paper describing the overall rate and identifying factors associated with non-home discharge specifically in the ≥ 80 years CRC population. Prospective studies are required to investigate causality and interventions to reduce non-home discharge rates.
本研究旨在确定80岁及以上成年结直肠癌（CRC）患者的非家庭出院率，并识别与非家庭出院相关的因素。这是第一项专门将非家庭出院作为80岁及以上结直肠癌队列研究结果的研究。
这是一项来自大型结直肠癌治疗中心的单中心回顾性探索性观察研究。纳入了2013年至2020年前瞻性收集的CRC数据库中年龄≥80岁的患者。通过评估电子病历以获取人口统计学、临床、功能和出院数据。进行单变量和多变量逻辑回归分析，以识别与主要研究结果非家庭出院相关的因素。次要结果包括出院处置和功能衰退。
242例年龄≥80岁的患者接受了CRC切除术。此外，234例患者和221例患者分别纳入总体和亚组非家庭出院分析。术前居家的队列中非家庭出院率为19.9%。在多变量逻辑回归分析中，在调整其他显著变量后，虚弱（比值比（OR）2.91，95%置信区间1.25 - 6.75，p = 0.013）、严重并发症（OR 3.92，95%置信区间1.40 - 10.97，p = 0.009）和开放手术（OR 3.93，95%置信区间1.87 - 8.24，p < 0.001）与显著更高的非家庭出院率相关。非家庭出院组中居家患者功能衰退的发生率为72.4%，而回家患者为16.7%（p < 0.001）。
这是第一篇描述80岁及以上CRC患者总体非家庭出院率并识别相关因素的论文。需要进行前瞻性研究以调查因果关系并采取干预措施降低非家庭出院率。
