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首页> 外文期刊>Surgical Endoscopy >Can laparoscopy for colon resection reduce the need for discharge to skilled care facility?
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Can laparoscopy for colon resection reduce the need for discharge to skilled care facility?

机译：腹腔镜结肠切除术可以减少出院到专业护理机构的需求吗？

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A significant proportion of patients, especially the elderly undergoing colon resections, are likely to be discharged to a skilled care facility. This study aims to examine whether the technique of colectomy, open versus laparoscopic, contributed to their discharge to a skilled care facility.This was a retrospective analysis using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Adult patients who underwent colectomy in 2009 were evaluated. SAS and SUDAAN software were used to provide weighted estimates and to account for the complex sampling design of the NIS. We compared routine discharge to nonroutine discharge, defined as transfer to short-term hospital, skilled nursing facility, intermediate care, home health, or another type of facility.A weighted total of 221,294 adult patients underwent colectomy in 2009 and had the primary outcome of discharge available. Of these colon resections, 70,361 (32 %) were performed laparoscopically and 150,933 (68 %) by open technique. A total of 139,047 (62.8 %) patients had routine discharge and 73,572 (33.3 %) nonroutine. A total of 8,445 (3.8 %) patients died while in the hospital, and 229 (0.1 %) left against medical advice and were excluded from further analysis. On univariate analysis, age ≥ 65 years, female gender, Black/Hispanic race, open technique (compared to laparoscopic), Medicare/Medicaid insurance status, comorbidity index of ≥ 1, and malignant primary diagnosis predicted nonroutine discharge. A multivariate logistic model was then used to predict nonroutine discharge in these patients using variables significant in the univariate analysis at the α = 0.05 significance level. In the multivariate analysis, open compared to laparoscopic technique was independently associated with increased likelihood of discharge to skilled care facilities (odds ratio 2.85, 95 % confidence interval 2.59-3.14).In addition to the expected factors like advancing age, female gender, and increasing comorbidity index, open compared to laparoscopic technique for colectomy is associated with an increased likelihood of discharge to skilled care facilities. When feasible, the laparoscopic technique should be considered as an option, especially in the elderly patients who require colon resection, because it may reduce their likelihood of discharge to a skilled care facility.
机译：很大一部分患者，尤其是接受结肠切除术的老年人，很可能会被送往专业护理机构。这项研究的目的是检查开放式和腹腔镜结肠切除术的技术是否有助于其向熟练护理机构的出院。这是一项使用来自全国住院患者样本（NIS），美国医疗保健费用和利用项目的出院数据的回顾性分析医疗保健研究和质量。对2009年接受结肠切除术的成年患者进行了评估。 SAS和SUDAAN软件用于提供加权估计并考虑NIS的复杂抽样设计。我们将常规出院与非常规出院进行了比较，常规出院定义为转移到短期医院，熟练护理机构，中间护理，家庭保健或其他类型的机构.2009年，共有221294名加权成年患者接受了结肠切除术，其主要结局是可用放电。在这些结肠切除术中，腹腔镜手术为70,361（32％），开放技术为150,933（68％）。共有139,047（62.8％）例行常规出院和73,572（33.3％）例行常规出院。在医院期间，共有8,445名患者（3.8％）死亡，另有229名（0.1％）接受医疗建议而被排除在进一步分析之外。在单因素分析中，年龄≥65岁，女性，黑人/西班牙裔，开放技术（与腹腔镜相比），医疗保险/医疗保险状况，合并症指数≥1以及恶性的初步诊断预测为非常规出院。然后使用多元逻辑模型预测这些患者的非常规出院，该变量使用在α= 0.05显着性水平下单变量分析中显着的变量。在多变量分析中，与腹腔镜技术相比，开放性与出院到熟练护理机构的可能性增加独立相关（赔率2.85,95％置信区间2.59-3.14）。此外，还包括预期的因素，例如年龄，女性性别和与腹腔镜结肠切除术相比，合并症指数增加，与腹腔镜技术开放相比，其出院可能性增加。在可行的情况下，应考虑选择腹腔镜技术，尤其是在需要进行结肠切除术的老年患者中，因为它可以减少他们出院到熟练护理机构的可能性。

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