肺癌肺切除术后救援失败的决定因素：来自全国住院样本的见解
Determinants of Failure to Rescue After Pulmonary Resection for Lung Cancer: Insights From a National Inpatient Sample.
作者
作者单位
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
- Department of Surgery, Division of Thoracic Surgery, Keck School of Medicine of USC, Los Angeles, California, USA.
摘要
中文
救援失败（FTR）定义为术后并发症后死亡，是一个既定的质量指标；然而，肺切除后的全国数据仍然有限。我们旨在确定与肺癌肺切除术后FTR相关的患者、手术和医院层面因素，并评估相关结果。使用全国住院样本（2016-2022年）确定接受择期肺癌肺切除并发生≥1种主要并发症的成人。FTR定义为住院死亡率。多变量逻辑回归确定了预测因素。次要结局包括住院时间、费用和出院去向。在14,575名有主要并发症的患者中，FTR发生率为2.6%。虚弱（OR 3.44，95% CI 2.73-4.35）和合并症负担（Elixhauser ≥2：OR 4.87，1.54-15.43）是最强的预测因素。肺切除术（OR 2.78，1.82-4.23）、年龄≥75岁（OR 2.21，1.47-3.32）和开放手术（OR 1.78，1.41-2.24）也与之相关，而女性和私人保险具有保护作用。没有医院因素独立相关。FTR由患者脆弱性和手术复杂性驱动，而非医院特征。这些发现强调了对高风险患者进行术前风险分层和并发症管理，但不支持将区域化到高容量中心作为减少FTR的策略。
English
Failure to rescue (FTR), defined as death following a postoperative complication, is an established quality metric; however, national data after pulmonary resection remain limited. We aim to identify patient-, procedural-, and hospital-level factors associated with FTR after pulmonary resection for lung cancer and evaluate related outcomes. The National Inpatient Sample (2016-2022) was used to identify adults undergoing elective pulmonary resection for lung cancer who developed ≥ 1 major complication. FTR was defined as in-hospital mortality. Multivariable logistic regression identified predictors. Secondary outcomes included length of stay, costs, and discharge disposition. Among 14,575 patients with major complications, FTR occurred in 2.6%. Frailty (OR 3.44, 95% CI 2.73-4.35) and comorbidity burden (Elixhauser ≥ 2: OR 4.87, 1.54-15.43) were the strongest predictors. Pneumonectomy (OR 2.78, 1.82-4.23), age ≥ 75 years (OR 2.21, 1.47-3.32), and open approach (OR 1.78, 1.41-2.24) were also associated, while female sex and private insurance were protective. No hospital factors were independently associated. FTR is driven by patient vulnerability and procedural complexity rather than hospital characteristics. These findings emphasize preoperative risk stratification and complication management in high-risk patients but do not support regionalization to high-volume centers as a strategy to reduce FTR.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q2
- 影响因子
- 1.9
- 新锐分区
- 3区