头颈癌手术后住院时间延长：危险因素、临床结局及护理优化策略
Prolonged hospitalization following head and neck cancer surgery: risk factors, clinical outcomes, and strategies for care optimization.
文献信息
| PMID | 42966811 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Younghac Kim |
| 作者单位 | Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 本研究旨在识别头颈癌（HNC）手术后住院时间（LOS）延长的危险因素，评估其肿瘤学影响，并确定可临床操作以减少LOS的靶点。
方法： 我们回顾性审查了一个10年队列，纳入在三级转诊中心接受手术治疗的HNC患者（2013-2022年）。住院时间延长定义为住院超过第95百分位数（>24天），极长住院时间定义为超过第99百分位数（>73天）；平均LOS为10天的患者作为对照。使用多变量logistic回归评估危险因素，并使用分位数回归和网络分析评估术后并发症的相对重要性和相互关系。
结果： 在365例患者中，44例为极长LOS，182例为延长LOS，139例为对照。延长LOS与更多并发症和较差的肿瘤学结局相关，包括更高的复发率和疾病特异性死亡率。喉/下咽亚部位（比值比[OR]，4.95，95%置信区间[CI]，1.13-23.69）、既往手术（OR，10.60，95% CI，3.81-35.79）、吸烟（OR，0.26，95% CI，0.07-0.93）、气管切开（OR，3.62，95% CI，1.16-12.16）和术后并发症（OR，251.2，95% CI，29.9-33,729.2）是延长LOS的显著基线或术后相关因素。皮瓣失败是最具影响力的并发症，网络分析显示皮瓣失败、瘘、伤口坏死和感染之间存在强相互关系。
结论： HNC手术后住院时间延长与不良肿瘤学结局相关，这可能反映潜在疾病严重程度，并且主要由术后并发症驱动，尤其是皮瓣相关并发症，这是延长LOS最重要且可修改的决定因素。
英文摘要
PURPOSE: This study aimed to identify risk factors for prolonged hospital length of stay (LOS) following head and neck cancer (HNC) surgery, evaluate its oncologic impact, and identify clinically actionable targets to reduce LOS.
METHODS: We retrospectively reviewed a 10-year cohort of HNC patients treated surgically at a tertiary referral center (2013-2022). Prolonged LOS was defined as hospitalization exceeding the 95th percentile (> 24 days) and extremely prolonged LOS as exceeding the 99th percentile (> 73 days); patients with a mean LOS of 10 days served as controls. Risk factors were assessed using multivariable logistic regression, and quantile regression and network analyses evaluated the relative importance and interrelationships of postoperative complications.
RESULTS: Of 365 patients, 44 had extremely prolonged LOS, 182 had prolonged LOS, and 139 were controls. Prolonged LOS was associated with more complications and poorer oncologic outcomes, including higher recurrence and disease-specific mortality. Laryngeal/hypopharyngeal subsite (odds ratio [OR], 4.95, 95% confidence interval [CI], 1.13-23.69), previous surgery (OR, 10.60, 95% CI, 3.81-35.79), smoking (OR, 0.26, 95% CI, 0.07-0.93), tracheostomy (OR, 3.62, 95% CI, 1.16-12.16), and postoperative complications (OR, 251.2, 95% CI, 29.9-33,729.2) were significant baseline or postoperative correlates of prolonged LOS. Flap failure was the most influential complication, and network analysis revealed strong interrelationships among flap failure, fistula, wound necrosis, and infection.
CONCLUSION: Prolonged hospitalization after HNC surgery is associated with adverse oncologic outcomes which may reflect underlying disease severity, and is primarily driven by postoperative complications, particularly flap-related complications, the most important and modifiable determinant of prolonged LOS.