Travel distance influences readmissions in colorectal cancer patientsd-what the primary operative team needs to know
Travel distance influences readmissions in colorectal cancer patientsd-what the primary operative team needs to know
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DOI：
10.1016/j.jss.2018.02.022
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发表时间：
2018-07-01
影响因子：
2.2
通讯作者：
Tsikitis, V. Liana
中科院分区：
文献类型：
--
作者：
Kelley, Katherine A.;Young, J. Isaac;Tsikitis, V. Liana
背景：许多结直肠癌患者远程接受复杂的手术护理。我们假设在考虑到主要/转诊医院的出行距离差异并与死亡率相关后，他们的再入院率将受到不利影响。 材料和方法：我们在监测、流行病学和最终结果 (SEER)-医疗保险数据库中确定了 48,481 名结直肠癌患者。使用 Google 地图和 SAS 计算旅行距离。使用多变量负二项回归来确定与再入院率相关的因素。使用 KaplaneMeier 和 Cox 比例风险分析总体生存率。 结果和结论：14.9% 的队列患者在 30 天后再次入院，其中 27.5% 前往非指数医院。在结肠癌和直肠癌队列中，再入院率分别为 14.5% 和 16.5%。直肠癌患者的再入院率增加了 13%（发病率比 [IRR] 1.13；95% 置信区间 [CI] 1.05-1.21）。与再入院相关的因素包括男性、晚期疾病、住院时间（LOS）、出院处置、住院量、查尔森评分和贫困水平（P < 0.05）。旅行距离越远增加了再次入院的可能性，但不影响死亡率。旅行距离影响再入院率，但不影响死亡率。对于从指标医院出院的结直肠癌患者来说，做好出院准备以减少再入院至关重要。 (C) 2018 Elsevier Inc. 保留所有权利。
Background: Many colorectal cancer patients receive complex surgical care remotely. We hypothesized that their readmission rates would be adversely affected after accounting for differences in travel distance from primary/index hospital and correlate with mortality.Materials and methods: We identified 48,481 colorectal cancer patients in the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Travel distance was calculated, using Google Maps, and SAS. Multivariate negative binomial regression was used to identify factors associated with readmission rates. Overall survival was analyzed, using KaplaneMeier and Cox proportional hazard.Results and conclusions: Thirty-day readmissions occurred in 14.9% of the cohort, 27.5% of which were to a nonindex hospital. In the colon and rectal cancer cohorts, readmissions were 14.5% and 16.5%, respectively. Rectal cancer patients had an increase in readmission by 13% (incidence rate ratios [IRR] 1.13; 95% confidence interval [CI] 1.05-1.21). Factors associated with readmission were male gender, advanced disease, length of stay (LOS), discharge disposition, hospital volume, Charlson score, and poverty level (P < 0.05). Greater distance traveled increased the likelihood of readmission but did not affect mortality. Travel distance influences readmission rates but not mortality. Discharge readiness to decrease readmissions is essential for colorectal cancer patients discharged from index hospitals. (C) 2018 Elsevier Inc. All rights reserved.