Hospital readmission after ovarian cancer surgery: Are we measuring surgical quality?
Hospital readmission after ovarian cancer surgery: Are we measuring surgical quality?
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卵巢癌手术后再入院：我们是否衡量手术质量？
DOI：
10.1016/j.ygyno.2017.05.012
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发表时间：
2017
影响因子：
4.7
通讯作者：
Gehrig,PaolaA
中科院分区：
文献类型：
--
作者：
Barber,EmmaL;Doll,KemiM;Gehrig,PaolaA
目的：手术后再入院是一个质量指标，用来反映住院治疗的质量。我们研究了再入院和手术质量的替代品之间的联系-主要的术后并发症-卵巢癌patients.MethodsPatients谁接受手术治疗卵巢癌2012年和2013年之间被确定从国家手术质量改进项目（NSQIP）。严重并发症定义为经验证的Claviden-Dindo量表上的3级或≥并发症，包括基于再入院ICD-9代码的NSQIP和非NSQIP定义的并发症。再入院和并发症在30天内的手术进行了分析，使用率比和改良Poisson regression.ResultsWe确定了2806卵巢癌患者，其中9.1%（n = 259）经历了计划外再入院。总体严重并发症发生率为10.9%（n = 307）。首次住院的严重并发症与随后的再入院无关（RR 1.2，95% CI 0.7-1.9）。总的来说，41.4%的再入院与任何重大术后并发症无关。在计划外再入院中，55.2%（n = 143）从未发生NSQIP定义的重大并发症。在这143例患者中，107例患者的再入院原因已知，分别为：28.0%非NSQIP定义的重大并发症; 16.8%癌症或其他医学因素; 22.4%轻微并发症; 32.7%结论卵巢癌手术后40%的计划外再入院发生在没有经历过重大术后并发症的患者中，并发症质量指标基准和减少再入院的努力应该占与重大并发症无关的再入院的高百分比。
ObjectivesReadmission after surgery is a quality metric hypothesized to reflect the quality of care in the index hospitalization. We examined the link between readmissions and a surrogate of surgical quality – major postoperative complication – among ovarian cancer patients.MethodsPatients who underwent surgery for ovarian cancer between 2012 and 2013 were identified from the National Surgical Quality Improvement Project (NSQIP). Major complications were defined as grade 3 or ≥ complications on the validated Claviden-Dindo scale and included both NSQIP and non-NSQIP defined complications based on readmission ICD-9 code. Readmissions and complications within 30-days of surgery were analyzed using rate ratios and modified Poisson regression.ResultsWe identified 2806 ovarian cancer patients of whom 9.1% (n = 259) experienced an unplanned readmission. Overall major complication rate was 10.9% (n = 307). Major complications in the index hospitalization were not associated with subsequent readmission (RR 1.2, 95% CI 0.7–1.9). Overall, 41.4% of readmissions were not attributable to any major postoperative complication. Of the unplanned readmissions, 55.2% (n = 143) never experienced a NSQIP-defined major complication. Of these 143 patients, the reason for readmission was known for 107 patients and was: 28.0% non-NSQIP-defined major complications; 16.8% cancer or other medical factors; 22.4% minor complications; and 32.7% symptoms without a diagnosis of complication.ConclusionsForty percent of unplanned readmissions after ovarian cancer surgery occur among patients who have not experienced a major postoperative complication. Quality metric benchmarks and efforts to decrease readmissions should account for this high percentage of readmissions not associated with a major complication.