Tartter P I
Department of Surgery, Mount Sinai Medical Center, New York, 10029, USA.
Ann Surg. 1996 Apr;223(4):351-6. doi: 10.1097/00000658-199604000-00002.
The author's objective was to determine whether the length of postoperative stay for patients after colorectal cancer surgery is associated with prognosis.
Financial pressure to reduce hospital costs has caused physicians to reduce hospital stays by changes in patient care, which reduce hospital stay but may compromise long-term results.
Using multivariate analysis, the author examined the relationship between postoperative stay and prognosis in a consecutive series of 341 prospectively studied patients with colorectal cancer undergoing potentially curative surgery.
In multivariate analysis, patients staying beyond the median of 11 days had more complications (p=0.000), more left hemicolectomies and procedures with colostomies (p=0.000), were older (p=0.002), and lost more blood (p=0.012) than patients staying less than the median. Disease-free survival was significantly and independently related to Dukes' stage (p=0.000), postoperative stay (p=0.001), and blood transfusion (p=0.011). The mean postoperative stay for the 98 patients who later developed recurrence was 15 days compared to 12 days for the 243 patients who remained disease free (p=0.0008). Cumulative disease-free survival of the 142 patients who stayed more than the median of 11 days was 60% compared to 77% for the 199 patients with shorter stays (p=0.000).
These data indicate that shorter hospital stays do not compromise disease-free survival of patients with colorectal cancer.
作者的目的是确定结直肠癌手术后患者的术后住院时间是否与预后相关。
降低医院成本的经济压力促使医生通过改变患者护理方式来缩短住院时间，这虽能缩短住院时间，但可能影响长期疗效。
作者采用多变量分析，研究了341例接受潜在根治性手术的前瞻性研究的连续结直肠癌患者中，术后住院时间与预后的关系。
多变量分析显示，住院时间超过中位数11天的患者比住院时间少于中位数的患者有更多并发症（p = 0.000）、更多左半结肠切除术和结肠造口术（p = 0.000）、年龄更大（p = 0.002）且失血更多（p = 0.012）。无病生存期与Dukes分期（p = 0.000）、术后住院时间（p = 0.001）和输血（p = 0.011）显著且独立相关。98例后来复发的患者术后平均住院时间为15天，而243例无病患者为12天（p = 0.0008）。住院时间超过中位数11天的142例患者的累积无病生存率为60%，而住院时间较短的199例患者为77%（p = 0.000）。
这些数据表明，较短的住院时间不会影响结直肠癌患者的无病生存期。
