在不复杂的选择性大肠切除术后早出院,以及出院后复杂症的风险
Michael Balas1, Fayez Quereshy1,2, Jordan Bohnen3
1From the Temerty Faculty of Medicine (Balas, Quereshy, Jung), University of Toronto, Toronto, ON, Canada.
Journal of the American College of Surgeons
|November 1, 2023
概括
在没有并发症的切除术后的早期出院是对最小侵入性手术安全的,减少了出院后的并发症. 这一发现支持临床判断在选择患者提前出院,优化患者的结果.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 手术结果研究研究.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 回顾性队列研究分析了接受无并发性选择性切除术的成年患者 (2012年1月至2019年12月).
- 如果没有报告在医院出现并发症,那么结肠切除术被定义为无并发症.
- 专注于排放时间和排放后并发症之间的关联.
研究的目的:
- 检查提前出院和出院后并发症之间的关联.
- 研究早期出院协议的安全性和有效性.
- 评估临床判断在选择患者提前出院.
主要方法:
- 将患者分层分为早期 (镜/机器人 ≤3天,开放 ≤5天) 和延迟放出组.
- 使用的倾向得分匹配用于比较.
- 使用未调整后勤回归分析出院后的并发症.
主要成果:
- 在腹腔镜切除术 (OR 0.73) 和机器人切除术 (OR 0.63) 中,早出院与更低的出院后并发症几率有关.
- 开放式切除术的并发症几率没有显著差异 (OR 1.02).
- 没有临床上有意义的差异,在所有方法返回手术室.
结论:
- 早期出院是安全的,并且与最小侵入性切除术中的并发症减少有关.
- 这些发现支持手术团队在确定适合提前出院的候选人的临床判断.
- 建议优化医院资源利用和患者康复途径的潜力.
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