[Factors associated with readmission within three months of surgery for gastric cancer and their long-term effects on patients' nutritional status and quality of life].

Objective: To analyze the factors associated with readmission within three months of surgery for gastric cancer and the impact of readmission on patients' long-term nutritional status and quality of life. Methods: This was a prospective cohort study comprising patients who underwent radical gastrectomy in the Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences from October 2018 to August 2019. Patients who failed to complete postoperative follow-up, whose body mass index (BMI) could not be accurately estimated, or who were unable to complete a quality-of-life questionnaire were excluded. The patients were followed up for 12 months. Time to, cause(s) of, and outcomes of readmission were followed up 1, 2 and 3 months postoperatively. BMI was followed up 1, 3, 6 and 12 months postoperatively. Results of blood tests were collected and patients' nutritional status and quality of life were assessed 12 months postoperatively. Nutritional status was evaluated by BMI, hemoglobin, albumin, and total lymphocyte count. Quality of life was evaluated using the European Organization for Research in the Treatment of Cancer (EORTC) Quality of Life scale. The higher the scores for global health and functional domains, the better the quality of life, whereas the higher the score in the symptom domain, the worse the quality of life. Results: The study cohort comprised 259 patients with gastric cancer, all of whom were followed up for 3 months and 236 of whom were followed up for 12 months. Forty-four (17.0%) patients were readmitted within 3 months. The commonest reasons for readmission were gastrointestinal dysfunction (16 cases, 36.3%), intestinal obstruction (8 cases, 18.2%), and anastomotic stenosis (8 cases, 18.2%). Logistic regression analysis showed that preoperative Patient-Generated Subjective Global Assessment score ≥ 4 points (OR=1.481, 95% CI: 1.028‒2.132), postoperative complications (OR=3.298, 95%CI:1.416‒7.684) and resection range (OR=1.582, 95% CI:1.057‒2.369) were risk factors for readmission within 3 months of surgery. Compared with patients who had not been readmitted 12 months after surgery, patients who were readmitted within 3 months of surgery tended to have greater decreases in their BMI [-2.36 (-5.13,-0.42) kg/m2 vs. -1.73 (-3.33,-0.33) kg/m2, Z=1.850, P=0.065), significantly lower hemoglobin and albumin concentrations [(122.1±16.6) g/L vs. (129.8±18.4) g/L, t=2.400, P=0.017]; [(40.9±5.0) g/L vs. (43.4±3.3) g/L, t=3.950, P<0.001], and significantly decreased global health scores in the quality of life assessment [83 (67, 100) vs. 100 (83, 100), Z=2.890,P=0.004]. Conclusion: Preoperative nutritional risk, total or proximal radical gastrectomy, and complications during hospitalization are risk factors for readmission within 3 months of surgery for gastric cancer. Perioperative management and postoperative follow-up should be more rigorous. Readmission within 3 months after surgery may be associated with a decline in long-term nutritional status and quality of life. Achieving improvement in long-term nutritional status and quality of life requires tracking of nutritional status, timely evaluation, and appropriate interventions in patients who need readmission.目的： 分析胃癌根治术后患者3个月内非计划再入院的发生原因，以及再住院对患者长期营养状态及生活质量的影响。 方法： 本研究为前瞻性随访研究，纳入中国医学科学院肿瘤医院胰胃外科2018年10月至2019年8月行胃癌根治性手术患者，剔除未能完成术后随访或无法准确测量体质量和完成生活质量问卷调查的患者。术后随访12个月，第1、2、3个月问卷随访再入院发生时间、原因以及转归；术后第1、3、6个月随访患者体质指数；术后1年进行生化指标检测并评估患者体质指数、营养状况和生活质量。其中营养状况采用体质指数和血红蛋白、白蛋白、淋巴细胞总数相关血液检查指标评估。生活质量采用欧洲癌症治疗研究组织（EORTC）生活质量测定量表评价，总体健康状况和功能领域得分越高，说明生活质量越好；症状领域得分越高，说明生活质量越差。 结果： 共纳入胃癌患者259例，全部病例完成3个月的随访，236例完成12个月的随访。术后3个月内非计划再入院44例（17.0%），主要包括胃肠功能障碍16例（36.3%）、肠梗阻8例（18.2%）、吻合口狭窄8例（18.2%）。logistic回归分析显示，术前主观整体营养状况评分≥4分（OR=1.481，95%CI：1.028~2.132）、术后并发症（OR=3.298，95%CI：1.416~7.684）和切除范围（OR=1.582，95%CI：1.057~2.369）为本组患者术后3个月内再入院的独立危险因素（均P<0.05）。术后12个月，与未再入院患者相比，术后3个月内再入院患者体质指数存在下降趋势［-2.36（-5.13，-0.42）kg/m2 比-1.73（-3.33，-0.33）kg/m2，Z=1.850，P=0.065］；血红蛋白和白蛋白水平更低［（122.1±16.6）g/L比（129.8±18.4）g/L，t=2.400，P=0.017；（40.9±5.0）g/L比（43.4±3.3）g/L，t=3.950，P<0.001］；生活质量中总体健康状况评分降低［83（67，100）分比100（83，100）分，Z=2.890，P=0.004］。 结论： 术前存在营养风险、行全胃或近端胃癌根治术以及住院期间发生并发症为患者术后3个月内再入院的危险因素。应对此类患者加强围手术期管理和术后随访。术后3个月内再入院患者可能造成远期营养状态和生活质量下降，应对已经发生再入院患者，进行营养跟踪，及时给予评估和干预，提高患者远期营养状况和生活质量。.