大腸がんの術後在院日数に影響する因子としての歩行開始日の意義

Importance of Initial Ambulation as a Factor Influencing Length of Hospital Stay after Surgery for Colorectal Cancer

要旨　目的：大腸がん患者のリハビリテーション治療において術後早期歩行の可否が術後退院遅延に影響するのかを明らかにすることである．

方法：本研究は，浦添総合病院にて実施された後方視的観察研究である．対象は，2019年6月〜2021年12月に大腸がんに対する予定手術が施行され，術前リハビリテーション介入依頼があった症例とした．患者基本属性や手術関連項目，リハビリテーション医療関連項目を診療録より抽出した．術後在院日数に対する歩行開始日のカットオフ値を算出し，それをもとに中央値にて早期退院と退院遅延に2群に分類した．術後在院日数における退院遅延への各評価項目の影響についてロジスティック回帰分析を行った．

結果：本研究の解析対象者は184例となった．単変量解析の結果では，直腸がん，手術時間，出血量，Clavien-Dindo分類gradeⅡ以上の合併症，歩行開始日が有意な可能性のある因子として抽出された．それらを投入した多変量解析において，術後合併症，手術時間，歩行開始日が術後在院日数に影響する有意な独立因子であることが示された．

結論：大腸がん患者のリハビリテーション治療において術後早期歩行の可否が術後退院遅延に影響する可能性が明らかとなった．臨床場面で治療を実施する際には，術後3日目までに歩行に進展することの重要性が示された．

Abstract　Objective：This study investigated whether the day of initial ambulation during rehabilitation affects postoperative outcomes in patients with colorectal cancer.

Methods：This retrospective observational study was conducted at the Urasoe General Hospital. Patients who underwent scheduled surgery and requested preoperative rehabilitation between June 2019 and December 2021 were included in this study. Patient characteristics and surgery- and rehabilitation-related data were retrieved from the medical records. The patients were divided into early- and late-discharge groups according to their median postoperative hospital stay. The cut-off value of initial ambulation during the postoperative hospital stay was calculated, and logistic regression analysis was performed to determine the impact of initial ambulation on delayed postoperative hospital stay.

Results：This study included 184 patients. The cutoff value for initial ambulation during the postoperative hospital stay was three days. In the univariate analysis, rectal cancer, operation time, blood loss, postoperative complications of Clavien-Dindo classification grade II or higher, and the initial ambulation day were identified as potentially significant factors. In the multivariate analysis, which included these potentially significant factors as input variables, postoperative complications, operation time, and the initial ambulation day were determined to be significant independent factors affecting postoperative hospital stay.

Conclusion：The initial ambulation day can affect postoperative hospital stay in patients with colorectal cancer. It is important that the rehabilitation interventions undertaken after colorectal cancer surgery facilitate ambulation within the third postoperative day.