一个随机的,受控的试验评估术后风险分层和基于风险的,在选择性重大癌症手术后基于协议的管理.
Nestor F Esnaola1,2, Raju Chelluri2, Jason Castellanos2
1Department of Surgery, Houston Methodist Hospital, Houston, TX.
Annals of surgery
|July 24, 2024
概括
基于风险的管理并没有减少重大癌症手术后的死亡或严重并发症. 这种方法也显示,与常规护理相比,患者的治疗结果或医疗保健使用情况没有改善.
科学领域:
- 在瘤学瘤学.
- 手术护理 手术护理
- 患者的治疗结果.
背景情况:
- 大型癌症手术带来了显著的外科手术期间风险.
- 这些风险可能会对患者的长期结果产生负面影响.
研究的目的:
- 评估基于风险的,以协议为导向的管理是否可减少选择性重大癌症手术后的30天死亡或严重并发症 (DSC).
- 为了比较这种密集管理策略与通常的护理.
主要方法:
- 1529名接受选择性重大癌症手术的成年患者被随机分类.
- 患者接受了基于风险的管理或通常的护理.
- 主要结局是DSC的30天率;次要结局包括并发症,存活率和生活质量.
主要成果:
- 在基于风险的管理下,30天的DSC率为15.0%,在常规护理下为14.1% (P=0.65).
- 在并发症,不良事件,停留时间,出院回家,再入院或接受抗瘤治疗方面没有发现显著差异.
- 长期整体存活率和无病存活率在各组之间也相似.
结论:
- 与常规护理相比,基于风险的,以协议为导向的管理没有降低30天DSC率在重大癌症手术后.
- 该干预措施没有改善术后医疗保健利用率,生活质量或癌症结局.
- 需要进一步的研究,以找到具有成本效益的,量身定制的术后治疗策略,以优化这些患者的治疗结果.
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