营养风险筛查评分与胃癌术后 30 d 内非计划再入院的关系

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摘要目的探讨胃癌术后 30 d 内非计划性再入院的发生率和风险因素,明确营养风险筛查 2002(NRS 2002)工具对非计划性再入院的预测价值。方法收集 2016 年 1 月至 2022 年 1 月之间在南京医科大学附属南京医院接受根治性手术切除的 312 例胃癌患者,分析胃癌术后非计划性再入院的发生率及原因。将所有患者分为再入院组( 26 例) 与非再入院组( 286 组),比较组间基线特征的分布。对患者人口学资料、临床病理特征及围手术期等数据进行单、多因素 Logistic 回归分析,确定非计划性再入院的独立风险因素。结果根据 NRS 2002 评分,33. 0%(103 / 312)的胃癌患者存在术前营养不良风险(NRS 2002 评分≥ 3 分)。胃癌术后 30 d 内非计划性再入院率为 8. 3%(26 / 312),首次出院至再入院的平均时间间隔为(10. 8±7. 4) d。术后肠梗阻(19. 2%,5 / 26)和腹水/ 腹腔感染(15. 4%,4 / 26)是胃癌患者术后再入院最常见的原因。单、多因素 Logistic 回归分析结果表明示 NRS 2002 评分≥ 3 分(OR = 3. 259, 95%CI = 1. 357 ~ 7. 828, P = 0. 008)、年龄≥65 岁 (OR = 3. 212, 95%CI = 1. 256~ 8. 213, P = 0. 015)、术后并发症 (OR = 3. 407, 95% CI = 1. 258 ~ 9. 226, P = 0. 016) 以及手术时间≥180 min (OR = 2. 734, 95%CI = 1. 108~ 6. 746, P= 0. 029)是胃癌术后非计划性再入院的独立危险因素。结论 NRS 2002 评分可作为预测胃癌术后 30 d 非计划再入院的一项有效工具,这一发现进一步强调了优化患者术前营养状态对改善围手术期不利结局的重要性。

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	王璇
	吴贤翠
	张云霞
	张婧

关键词 ：胃癌, 非计划性再入院, 术后并发症, 营养风险筛查 2002, 营养不良

Abstract：Objective To investigate the incidence and risk factors for unplanned hospital readmission within 30 days in gastric cancer patients who underwent curative gastrectomy and clarify the predictive value of nutritional risk screening 2002 NRS 2002 tool for unplanned readmission. Method This retrospective analysis included 312 patients who underwent curative gastrectomy for gastric cancer in Nanjing Hospital Affiliated to Nanjing Medical University between January 2016 and January 2022. The incidence and causes of unplanned readmission after curative gastrectomy for gastric cancer were analyzed. All patients were divided into readmission 26 and non-readmission 286 group and the distribution of baseline characteristics between the two groups was compared. The univariate and multivariate logistic regression analysis was conducted to identify the independent risk factors for unplanned readmission. Result According to the NRS 2002 scale 33. 0% 103 / 312 of gastric cancer patients were at risk of preoperative malnutrition NRS 2002 score ≥ 3 points . The unplanned readmission rate within 30 days was 8. 3% 26 / 312 for gastric cancer patients who underwent curative gastrectomy and the average time interval from discharge to readmission was 10. 8 ± 7. 4 days. Postoperative ileus 19. 2% 5 / 26 and intra-abdominal fluid collection / infection 15. 4% 4 / 26 were the main causes of hospital readmission. The univariate and multivariate logistic regression analysis demonstrated that NRS 2002 score ≥ 3 points OR = 3. 259 95% CI = 1. 357-7. 828 P= 0. 008 patient age ≥ 65 years OR= 3. 212 95%CI = 1. 256-8. 213 P= 0. 015 the presence of postoperative complications OR= 3. 407 95%CI = 1. 258-9. 226 P = 0. 016 and operation time ≥ 180 min OR= 2. 734 95%CI = 1. 108-6. 746 P= 0. 029 were independent risk factors for unplanned readmission in gastric cancer patients who underwent curative gastrectomy. Conclusion The NRS 2002 was an effective tool to predict unplanned readmission after curative gastrectomy for gastric cancer. This finding further emphasized the importance of optimizing preoperative nutritional status to improve the adverse perioperative outcomes.

收稿日期: 2022-08-25

基金资助:“六大人才高峰”高层次人才选拔培养资助项目(WSW-005)

通讯作者: 吴贤翠,电子邮箱:810150136@ qq. com

引用本文:

王璇,吴贤翠,张云霞,张婧. 营养风险筛查评分与胃癌术后 30 d 内非计划再入院的关系[J]. 肿瘤代谢与营养电子杂志, 2023, 10(1): 120-126.
Wang Xuan,Wu Xiancui, Zhang Yunxia, Zhang Jing. Relationship between nutritional risk screening 2002 and unplanned hospital readmission within 30 days after curative gastrectomy for gastric cancer. Electron J Metab Nutr Cancer, 2023, 10(1): 120-126.