Outpatient Transarterial Chemoembolization of Hepatocellular Carcinoma: Review of a Same-Day Discharge Strategy.
J Vasc Interv Radiol
; 29(4): 550-555, 2018 04.
Article
em En
| MEDLINE
| ID: mdl-29478795
ABSTRACT
PURPOSE:
To test the hypothesis that same-day discharge of selected transarterial chemoembolization patients would not increase 30-day readmission rate compared with overnight observation. MATERIALS ANDMETHODS:
With institutional review board approval, 193 hepatocellular carcinoma patients who underwent transarterial chemoembolization from July 2013 to June 2016 were reviewed. Treatment was conventional/lipiodol transarterial chemoembolization with 50 mg doxorubicin/10 mg mitomycin-c/particles or drug-eluting embolics transarterial chemoembolization with 50-75 mg doxorubicin/vial. At 3 hours, patients tolerating oral intake and not requiring intravenous analgesics were considered for discharge. The primary outcome measure was 30-day readmission for observation versus discharge using chi-squared (χ2) analysis. The secondary aim was to identify baseline or treatment variables independently associated with readmission, including Child-Pugh class, medically managed encephalopathy or ascites, patient age (<65 vs ≥65), tumor number (1 or >1), and level of embolization (segmental vs lobar).RESULTS:
Patients underwent 261 transarterial chemoembolization procedures. The 30-day readmission rate was not significantly different between observed patients (n = 179, 9.0%) and discharged patients (n = 82, 13.8%; P = .33). Readmission was not related to the selected agent (conventional/lipiodol-transarterial chemoembolization, 11.0% vs drug-eluting embolics transarterial chemoembolization, 7.5%; P = .36). Baseline variables associated with readmission were Child-Pugh B/C (χ2 = 7.9, P < .01), history of encephalopathy (χ2 = 15.4, P < 0.01), and ascites (χ2 = 4.4, P < .05). Patient age (<65 vs ≥65), tumor number (1 vs >1), and level of embolization (segmental vs lobar) were not predictive of readmission (all P > .05).CONCLUSIONS:
Same-day discharge after transarterial chemoembolization does not increase the risk of 30-day readmission. Child-Pugh B/C patients, as well as those with ascites or encephalopathy, have the highest risk of readmission.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pacientes Ambulatoriais
/
Quimioembolização Terapêutica
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Carcinoma Hepatocelular
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Neoplasias Hepáticas
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Vasc Interv Radiol
Assunto da revista:
ANGIOLOGIA
/
RADIOLOGIA
Ano de publicação:
2018
Tipo de documento:
Article