Predictors of prolonged length of stay after lobectomy for lung cancer: A society of thoracic surgeons general thoracic surgery database risk-adjustment model
Predictors of prolonged length of stay after lobectomy for lung cancer: A society of thoracic surgeons general thoracic surgery database risk-adjustment model
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DOI：
10.1016/j.athoracsur.2008.03.024
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发表时间：
2008-06-01
影响因子：
4.6
通讯作者：
Allen, Mark S.
中科院分区：
文献类型：
--
作者：
Wright, Cameron D.;Gaissert, Henning A.;Allen, Mark S.
背景。对于肺癌患者行肺叶切除术的手术风险，目前很少有可靠的估计。本研究确定了肺癌肺叶切除术后延长住院时间（PLOS）相关的危险因素，作为围手术期发病事件的替代指标。在胸外科学会（STS）普通胸外科数据库中查询肺癌肺叶切除术患者。通过多变量逐步logistic回归建立了术前危险因素模型，将PLOS的阈值设定为14天。发病率以STS数据库中定义的术后事件来衡量。将风险调整后的结果报告给参与站点。从2002年1月到2006年6月，在56个STS部位进行了4979例肺叶切除术，其中351例（7%）有PLOS。他们比没有PLOS的患者有更多的术后事件（3.4 vs 1.2; p < 0.0001）。PLOS患者的死亡率也高于LOS正常患者，分别为10.8%（351例中的38例）和0.7%（4628例中的33例；p < 0.0001）。PLOS的显著预测因子包括每10年的年龄（比值比[OR]， 1.30, p < 0.001）、Zubrod评分（比值比[OR]， 1.51, p < 0.001）、男性（比值比[OR]， 1.45, p = 0.002）、美国麻醉学会评分（比值比[OR]， 1.54, p < 0.001）、胰岛素依赖型糖尿病（比值比[OR]， p < 0.001）。1.71;p = 0.037)、肾功能不全（OR, 1.79; p = 0.004）、诱导治疗（OR, 1.65; p = 0.001）、预测1秒内以10%增量用力呼气量百分比（OR, 0.88; p < 0.001）和吸烟（OR, 1.33; p = 0.095）。经风险调整后，STS医院间PLOS存在双重差异。我们确定了重要的PLOS预测因子，这是肺癌肺叶切除术后的替代发病率指标。该模型可用于提供有意义的风险调整后的结果与化粪池系统站点的比较，以提高质量。
Background. Few reliable estimations of operative risk exist for lung cancer patients undergoing lobectomy. This study identified risk factors associated with prolonged length of hospital stay (PLOS) after lobectomy for lung cancer as a surrogate for perioperative morbid events.Methods. The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database was queried for patients with lobectomy for lung cancer. A model of preoperative risk factors was developed by multivariate stepwise logistic regression setting the threshold for PLOS at 14 days. Morbidity was measured as postoperative events as defined in the STS database. Risk-adjusted results were reported to participating sites.Results. From January 2002 to June 2006, 4979 lobectomies were performed for lung cancer at 56 STS sites, and 351 (7%) had a PLOS. They had more postoperative events than patients without PLOS (3.4 vs 1.2; p < 0.0001). Patients with PLOS also had higher mortality than those with normal LOS, at 10.8% (38 of 351) vs 0.7% (33 of 4628; p < 0.0001). Significant predictors of PLOS included age per 10 years (odds ratio [ OR], 1.30, p < 0.001), Zubrod score (OR, 1.51; p < 0.001), male sex (OR, 1.45; p = 0.002), American Society of Anesthesiology score (OR, 1.54; p < 0.001), insulin-dependent diabetes (OR. 1.71; p = 0.037), renal dysfunction (OR, 1.79; p = 0.004), induction therapy (OR, 1.65; p = 0.001), percentage predicted forced expiratory volume in 1 second in 10% increments (OR, 0.88; p < 0.001), and smoking (OR, 1.33; p = 0.095). After risk adjustment, twofold interhospital variability existed in PLOS among STS sitesConclusions. We identified significant predictors of PLOS, a surrogate morbidity marker after lobectomy for lung cancer. This model may be used to provide meaningful risk-adjusted outcome comparisons to STS sites for quality improvement purposes.