PO.CL09.03 · 临床研究
术前白蛋白与软组织肉瘤切除术后非计划性再入院相关
Preoperative albumin is associated with unplanned readmission following soft tissue sarcoma resection
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
引言：软组织肉瘤（STS）的治疗以手术切除为核心。术后再入院很常见，且与患者发病率和医疗成本增加相关。本研究旨在识别非计划性再入院的风险因素并量化此类事件的成本。
实验步骤：纳入2018至2022年间在一家三级转诊中心接受切除的四肢STS患者。收集人口学、合并症、肿瘤特征、治疗和手术发现。还获取了术后并发症、再入院、局部复发、再手术和疾病特异性生存。通过Pearson相关性检验评估再入院的风险因素。随后对p值< 0.2的变量采用二项逻辑回归建模。
结果：在131例患者中（平均随访21 ± 10个月），总体术后并发症率为36%，局部复发率为9%，再手术率为20%，疾病特异性生存率为96%。32%的患者发生非计划性再入院，平均在出院后19天（范围：6-121）。ASA分级、术前血红蛋白、术前白蛋白以及首次住院期间的并发症与再入院显著相关。经多变量分析后，术前血清白蛋白仍与非计划性再入院独立相关（OR = 0.077；95% CI = 0.005, 0.15）。平均再入院成本为$76,605.39（标准差：$101,981.78）。
结论：STS切除术后非计划性再入院很常见，且与巨大的经济负担相关。低术前血清白蛋白与再入院风险增加相关，凸显了术前营养优化和干预的潜在价值。需要具有更大患者队列和更多营养标志物的研究。
表. 患者特征及其与非计划性再入院的关联 人口学与合并症 P值 年龄（岁），均值（SD） 61 (16) 0.92 男性，n (%) 61 (54) 0.21 BMI (kg/m2)，均值（SD） 28 (6.4) 0.19 糖尿病，n (%) 21 (19) 0.10 COPD，n (%) 10 (9.2) 0.14 骨质疏松，n (%) 10 (9.2) 0.26 ASA分级，均值（SD） 2.6 (0.6) 0.0009 术前血清与肿瘤指标 P值 血红蛋白 (g/dL)，均值（SD） 12.7 (1.79) 0.03 白蛋白 (g/dL)，均值（SD） 4.02 (0.681) 0.001 肿瘤位置-下肢近端，n (%) 73 (64) 0.16 FNCLCC分级 (1/2/3)，n (%) 15 (13)/34 (30)/63 (57) 0.25 肿瘤大小 (cm)，均值（SD） 10.0 (1.5-40) 0.01 治疗与手术指标 P值 术前放疗，n (%) 61 (54) 0.14 手术时间（分钟），均值（SD） 468 (306) 0.05 估计失血量 (mL)，均值（SD） 172 (516) 0.05 住院时长（天），均值（SD） 4.3 (5.6) 0.05 手术住院期间并发症，n (%) 17 (15) 0.03 多变量分析后非计划性再入院的独立风险因素 OR (95% CI) P值 术前血清白蛋白 0.077 (0.005, 0.15) 0.03 糖尿病 1.4 (0.70, 2.1) 0.12 术前放疗 9 (0.98, 17.02) 0.07
查看英文原文 English abstract
Introduction: Treatment of soft tissue sarcomas (STS) revolves around surgical resection. Post-operative readmission is common and is associated with patient morbidity and increased healthcare costs. This study sought to identify risk factors for unplanned readmission and quantify the cost of such events.
Experimental Procedures: Extremity STS patients who underwent resection from 2018 to 2022 at a tertiary referral center were included. Demographics, comorbidities, tumor characteristics, treatment, and surgical findings were collected. Postoperative complications, readmissions, local recurrence, reoperations, and disease-specific survival were also obtained. Risk factors for readmission were evaluated via Pearson correlation testing. Binomial logistic regression modeling was subsequently utilized for variables with p-values < 0.2.
Results: Among 131 patients (mean follow-up 21 ± 10 months), overall postoperative complication rate was 36%, local recurrence rate was 9%, reoperation rate was 20%, and disease-specific survival rate was 96%. Unplanned readmission occurred in 32% of patients at a mean of 19 days after discharge (Range: 6-121). ASA class, preoperative hemoglobin, preoperative albumin, and complications during the index hospitalization were significantly associated with readmission. After multivariate analysis, preoperative serum albumin remained independently associated with unplanned readmission (OR = 0.077; 95% CI = 0.005, 0.15). Mean readmission cost was $76,605.39 (Standard Deviation: $101,981.78).
Conclusions: Unplanned readmission after STS resection is common and is associated with substantial financial burden. Low preoperative serum albumin is associated with increased readmission risk, underscoring the potential value of preoperative nutritional optimization and intervention. Studies with larger patient cohorts and additional nutritional markers are needed.
Patient Characteristics and their Associations with Unplanned Readmission Demographics and Comorbidities P-value Age (years), Mean (SD) 61 (16) 0.92 Male, n (%) 61 (54) 0.21 BMI (kg/m 2 ), Mean (SD) 28 (6.4) 0.19 Diabetes Mellitus, n (%) 21 (19) 0.10 COPD, n (%) 10 (9.2) 0.14 Osteoporosis, n (%) 10 (9.2) 0.26 ASA Class, Mean (SD) 2.6 (0.6) 0.0009 Preoperative Serum and Tumor Metrics P-value Hemoglobin (g/dL), Mean (SD) 12.7 (1.79) 0.03 Albumin (g/dL), Mean (SD) 4.02 (0.681) 0.001 Tumor Location - Proximal Lower Extremity, n (%) 73 (64) 0.16 FNCLCC Grade (1/2/3), n (%) 15 (13)/34 (30)/63 (57) 0.25 Tumor Size (cm), Mean (SD) 10.0 (1.5-40) 0.01 Treatment and Surgical Metrics P-value Preoperative Radiation, n (%) 61 (54) 0.14 OR Time (minutes), Mean (SD) 468 (306) 0.05 Estimated Blood Loss (mL), Mean (SD) 172 (516) 0.05 Hospital LOS (days), Mean (SD) 4.3 (5.6) 0.05 Complications During Operative Hospitalization, n (%) 17 (15) 0.03 Independent Risk Factors of Unplanned Readmission Following Multivariate Analysis OR (95% CI) P-value Preoperative Serum Albumin 0.077 (0.005, 0.15) 0.03 Diabetes Mellitus 1.4 (0.70, 2.1) 0.12 Preoperative Radiation 9 (0.98, 17.02) 0.07
利益披露 Disclosure
E. J. Kim, None..
C. M. Liu, None..
P. B. Haldeman, None..
M. Gedestad, None..
C. Trimm, None..
J. H. Flint, None..
F. Chiarappa, None.