Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality.
Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality.
复制标题
肺癌切除术后再入院与术后 90 天死亡率增加 6 倍相关。
DOI：
10.1016/j.jtcvs.2014.04.026
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发表时间：
2014-11
影响因子：
6
通讯作者：
Kozower, Benjamin D.
中科院分区：
文献类型：
--
作者：
Hu, Yinin;McMurry, Timothy L.;Isbell, James M.;Stukenborg, George J.;Kozower, Benjamin D.
术后再入院会影响患者护理和医疗费用。描述胸部手术后再入院的临床意义的全国范围内的数据很少。本研究的目的是评估肺癌切除术后再入院与死亡率之间的关系。从链接的 SEER-Medicare 登记处（2006-2011 年）提取肺癌切除患者的数据，包括人口统计、合并症、社会经济因素、出院后 30 天内的再入院以及 90 天的死亡率。重新入院设施和诊断已确定。在医院层面聚类的分层回归模型确定了再入院的预测因素。我们确定了 677 家医院的 11,432 名肺癌切除患者存活出院。中位年龄为 74.5 岁，52% 的患者接受了开放性肺叶切除术。 30 天再入院率为 12.8%，其中 28.3% 的再入院患者是在未进行原始手术的机构。再入院与 90 天死亡率增加六倍相关（14.4% vs. 2.5%，p <0.001）。最常见的再入院诊断是呼吸功能不全、肺炎、气胸和心脏并发症。与再入院相关的患者因素包括切除类型、年龄、既往诱导放化疗、术前合并症（包括充血性心力衰竭和慢性阻塞性肺病）以及低区域人口密度。与肺癌切除术后早期再入院相关的因素包括患者合并症、手术类型和社会经济因素。仅向手术提供者报告再入院情况的指标漏掉了所有病例的四分之一。重要的是，重新入院的患者死亡风险增加，需要最大程度的关注和最佳护理。
Postoperative readmission impacts patient care and healthcare costs. There is a paucity of nation-wide data describing the clinical significance of readmission following thoracic operations. The purpose of this study was to evaluate the relationship between postoperative readmission and mortality following lung cancer resection. Data were extracted for lung cancer resection patients from the linked SEER-Medicare registry (2006-2011), including demographics, comorbidities, socioeconomic factors, readmission within 30 days from discharge, and 90-day mortality. Readmitting facility and diagnoses were identified. A hierarchical regression model clustered at the hospital level identified predictors of readmission. We identified 11,432 lung cancer resection patients discharged alive from 677 hospitals. The median age was 74.5 years and 52% of patients received an open lobectomy. 30-day readmission rate was 12.8%, and 28.3% of readmissions were to facilities that did not perform the original operation. Readmission was associated with a six-fold increase in 90-day mortality (14.4% vs. 2.5%, p <0.001). The most common readmitting diagnoses were respiratory insufficiency, pneumonia, pneumothorax, and cardiac complications. Patient factors associated with readmission included resection type, age, prior induction chemoradiation, preoperative comorbidities including congestive heart failure and COPD, and low regional population density. Factors associated with early readmission following lung cancer resection include patient comorbidities, type of operation, and socioeconomic factors. Metrics that only report readmissions to the operative provider miss one-fourth of all cases. Importantly, readmitted patients have an increased risk of death and demand maximum attention and optimal care.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
影响因子：
9.6
作者：
Detterbeck, Frank C.;Boffa, Daniel J.;Tanoue, Lynn T.
通讯作者：
Tanoue, Lynn T.
DOI：
10.1093/jnci/djn389
发表时间：
2008-12-03
期刊：
Journal of the National Cancer Institute
影响因子：
--
作者：
Jemal A;Thun MJ;Ries LA;Howe HL;Weir HK;Center MM;Ward E;Wu XC;Eheman C;Anderson R;Ajani UA;Kohler B;Edwards BK
通讯作者：
Edwards BK
影响因子：
4.6
作者：
Freeman, Richard K.;Dilts, J. Russell;Mahidhara, Raja S.
通讯作者：
Mahidhara, Raja S.