尿路转移患者中医疗保健利用率和术后结果的变化:分析国家外科质量改善计划数据库
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Updated: Sep 20, 2025

08:09
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
11.6K
Anthony Fadel1, Bridget L Findlay1, Alexander M Pinkhasov1
1Department of Urology, Mayo Clinic, Rochester, Minnesota.
Urology practice
|May 27, 2025
概括
尿路转移 (UD) 的结果因病因而异. 医疗保健利用率和30天的发病率不同,取决于UD是膀癌还是其他良性/恶性疾病,需要量身定制的患者护理.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 外科手术的结果
- 医疗保健服务研究 医疗服务研究
背景情况:
- 尿路转移 (UD) 结果通常与膀癌 (BC) 程序进行基准测试.
- 对于非BC病因,包括其他癌症和良性疾病,进行大量的UDs.
- 关于不同UD病因的医疗保健利用率 (HU) 和发病率的比较数据有限.
研究的目的:
- 为了比较医疗保健利用率 (HU) 和30天的发病率在患者进行尿路转移 (UD) 良性与恶性病因.
- 确定术后结果的预测因素,包括长期停留 (PLOS),再入院,继续护理 (DCC) 和并发症.
- 为了评估各种UD指示中的脆弱性差异.
主要方法:
- 利用美国外科医生学院国家外科质量改善计划 (ACS-NSQIP) 数据库对20885名UD患者.
- 分类的UD指示为:初级膀癌 (BC),胃肠道/妇科癌 (GC),辐射 (R),间歇性囊炎/良性膀,神经性膀/肠道 (NGB).
- 采用风险调整回归模型和5项脆弱性指数来分析HU,PLOS,DCC,30天并发症和死亡率.
主要成果:
- 胃肠道/妇科癌症 (GC) 的并发症率 (71%) 和PLOS (50%) 率最高. 辐射 (R) 显示了最高的再入院率 (23%),神经性膀/肠 (NGB) 具有最高的DCC (30%).
- NGB和R组是最脆弱的 (分别为28%和27%的脆弱指数≥2).
- 患有R的脆弱患者有最高的HU (81%),而患有GC的脆弱患者有最高的并发症率 (77%). 与BC相比,PLOS,DCC和30天并发症的调整几率在病因方面有显著差异 (P < .05),不包括良性膀.
结论:
- 尿路转移 (UD) 病因显著影响术后医疗保健利用率和发病率.
- 接受UD患者的护理管理需要个性化,以病因为中心的方法.
- 膀癌 (BC) 尿路转移的结果不应作为所有UD程序的唯一基准,因为患者群体和复杂性各不相同.
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