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中华胸部外科电子杂志 ›› 2022, Vol. 09 ›› Issue (02) : 91 -99. doi: 10.3877/cma.j.issn.2095-8773.2022.02.05

肺小结节的精准外科治疗策略

胸外科手术患者出院后90 d内非计划再次入院分析
赵珂1, 王桂阁1, 张家齐1, 周梦馨1, 郭超1, 陈野野1, 黄诚1, 饶可2, 李单青1,()   
  1. 1. 100730 北京,中国医学科学院&北京协和医学院北京协和医院胸外科
    2. 100730 北京,中国医学科学院&北京协和医学院北京协和医院
  • 收稿日期:2022-02-21 修回日期:2022-04-25 接受日期:2022-04-28 出版日期:2022-05-28
  • 通信作者: 李单青

Analysis of unplanned readmissions within 90 days after discharge of thoracic surgery patients

Ke Zhao1, Guige Wang1, Jiaqi Zhang1, Mengxin Zhou1, Chao Guo1, Yeye Chen1, Cheng Huang1, Ke Rao2, Danqing Li1,()   

  1. 1. Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2. Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2022-02-21 Revised:2022-04-25 Accepted:2022-04-28 Published:2022-05-28
  • Corresponding author: Danqing Li
引用本文:

赵珂, 王桂阁, 张家齐, 周梦馨, 郭超, 陈野野, 黄诚, 饶可, 李单青. 胸外科手术患者出院后90 d内非计划再次入院分析[J]. 中华胸部外科电子杂志, 2022, 09(02): 91-99.

Ke Zhao, Guige Wang, Jiaqi Zhang, Mengxin Zhou, Chao Guo, Yeye Chen, Cheng Huang, Ke Rao, Danqing Li. Analysis of unplanned readmissions within 90 days after discharge of thoracic surgery patients[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2022, 09(02): 91-99.

目的

总结分析北京协和医院胸外科手术患者再次入院的发生率、发生时间、主要原因以及再次入院需要承担的经济负担,以期为减少术后患者再次入院提供借鉴。

方法

回顾性收集北京协和医院2011至2020年胸外科出院后90 d内非计划再入院患者的临床病历资料。根据手术部位、手术入路和再入院间隔时间进行亚组分析,并对组间差异进行比较。

结果

共纳入111名患者。所有患者的90 d和30 d非计划再入院率分别为0.71%和0.55%。非计划再入院的最常见原因是大量胸腔积液(36.9%)、感染(31.5%)、漏气(19.8%)。该研究的总体再入院时间为14(19.3±19.4)d。非计划再入院患者的平均二次住院时间为13.1(12.0)d。住院费用为(19 533.6±18 918.7)元,总体的有创操作率为79.3%。

结论

胸外科手术患者的非计划再入院是一个小概率事件。接受食管手术和非微创手术是非计划再入院的危险因素。大量胸腔积液、感染和漏气是所有患者非计划再入院的最常见原因。出院后的第2~3周是再入院风险最高的时间段。计划外的再入院会给患者带来额外的有创伤害、时间成本和经济负担。

Objective

To summarize and analyze the data on the incidence, time, main reasons, and financial burden of readmissions for thoracic surgery patients in Peking Union Medical College Hospital, to help reduce postoperative readmissions.

Methods

The clinical medical records of patients with unplanned readmission within 90 days after discharge from the Department of Thoracic Surgery in our hospital from 2011 to 2020 were retrospectively collected. Subgroup analyses were performed according to the surgical site, surgical approach, and readmission interval. Differences between means were compared using t-tests, and chi-square tests were used to assess differences between ratios. A statistically significant difference was defined as P<0.05.

Results

A total of 111 patients met the study inclusion criteria, and the 90-day and 30-day unplanned readmission rates were 0.71% and 0.55%, respectively. The most common reasons for unplanned readmission were massive pleural effusion (36.9%) , infection (31.5%) , and air leak (19.8%) . The overall median readmission time for the study was 14 days, and the mean readmission time was 19.3±19.4 days. The mean duration of second hospital stay for patients with unplanned readmissions was 13.1 (12.0) days. The average hospitalization cost was 19,533.6±18,918.7 yuan, and the overall invasive operation rate was 79.3%.

Conclusions

Our study shows that unplanned readmission of patients undergoing thoracic surgery is a small probability event. Receipt of esophageal surgery and non-minimally invasive surgery are risk factors for unplanned readmission. Massive pleural effusion, infection, and air leaks were the most common causes of unplanned readmissions in all patients. The 2–3 weeks after discharge is the period with the highest risk of readmission. Unplanned readmissions impose additional invasive harm, time cost, and financial burden on patients.

表1 患者的临床病历信息
项目 数值
性别[例(%)]  
  69(62.2)
  42(37.8)
疾病性质[例(%)]  
  良性 19(17.1)
  恶性 92(82.9)
主要诊断[例(%)]  
  肺部手术组 78(70.3)
    原发肺癌 65(58.6)
    支气管扩张 2(1.8)
    气胸 4(3.6)
    肺部慢性炎症 3(2.7)
    肺囊肿 1(0.9)
    肺转移癌 1(0.9)
    肺结核球 1(0.9)
    肺肉瘤 1(0.9)
  食管及贲门手术组 17(15.3)
    食管癌及贲门癌 16(14.4)
    食管憩室 1(0.9)
  纵隔肿物手术组 8(7.2)
    胸腺肿物 5(4.5)
    淋巴瘤 2(1.8)
    淋巴管瘤 1(0.9)
  其他手术组 8(7.2)
    胸壁肿物 5(4.5)
    肺癌 1(0.9)
    食管裂孔疝 1(0.9)
    淋巴结慢性炎症 1(0.9)
吸烟史[例(%)]  
  48(43.2)
  63(56.8)
饮酒史[例(%)]  
  23(20.7)
  88(79.3)
手术切除范围[例(%)]  
  肺楔形切除 16(14.4)
  肺段及肺叶切除 48(43.2)
  复合肺叶及全肺切除 13(11.7)
  食管憩室切除 1(0.9)
  食管癌切除 16(14.4)
  胸腺及胸腺肿物切除 7(6.3)
  多器官切除及重建 6(5.4)
  肋骨切除 2(1.8)
  淋巴结活检术 1(0.9)
  食管裂孔疝手术 1(0.9)
手术入路[例(%)]  
  微创组 60(54.1)
    三孔VATS 35(31.5)
    单操作孔VATS 14(12.6)
    微创McKeown 9(8.1)
    微创Ivor-Lewis 2(1.8)
  非微创组 51(45.9)
    正中开胸 4(3.6)
    侧开胸 29(26.1)
    VATS中转开胸 7(6.3)
    开放McKeown 1(0.9)
    开放Ivor-Lewis 4(3.6)
    其他开放切口 6(5.4)
二次入院有创操作[例(%)]  
  全身麻醉手术 32(28.8)
  局部麻醉操作 56(50.5)
    胸腔穿刺置管引流术 28(25.2)
    胸腔闭式引流术 19(17.1)
    其他 19(17.1)
  23(20.7)
首次手术返ICU[例(%)]  
  8(7.2)
  103(92.8)
首次手术输血[例(%)]  
  19(17.1)
  92(82.)
年龄(岁) 56.2±13.1
首次住院时间(d) 13.8±12.7
首次术后住院时间(d) 9.2±11.6
二次住院时间(d) 13.1±12.0
BMI(kg/m2 23.6±3.3
吸烟指数 351.1±566.0
首次入院日常生活能力评分 99.5±3.2
首次出院日常生活能力评分 67.8±16.4
首次住院生活能力评分变化 31.7±15.9
两次住院日常生活能力评分变化 23.0±19.9
首次手术时间(min) 195.2±103.7
首次出血量(mL) 207.4±226.0
引流管留置时间(d) 5.2±4.1
首次住院费用(元) 57 856.5±33 899.4
二次住院费用(元) 19 533.6±18 918.7
图1 不同手术部位再入院患者的比例
图2 不同手术部位再入院患者的再入院时间
图2 不同手术部位再入院患者的二次住院负担
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