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评估微创性大肠切除术后当天出院的结果:全国性的分析
Wardah Rafaqat1, Abiha Abdullah2, May Abiad1
1Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
微创小切除术后的当日出院 (SDD) 对特定患者是安全的. 这项研究发现,与短期住院相比,再入院或并发症的风险没有增加,这表明SDD是一个可行的选择.
科学领域:
- 外科手术的结果
- 最少侵入性的手术
- 结肠直肠手术 结肠直肠手术
背景情况:
- 结肠切除术后增强康复 结肠切除术协议正在不断发展,使一些患者能够在同一天出院 (SDD).
- 现有的SDD文献仅限于单个机构,这阻碍了概括性.
- 这项研究使用了国家数据集来比较SDD与短期住院的结果.
研究的目的:
- 为了比较同一天出院的患者和在术后第1或第2天出院的患者之间的30天再入院和出院后的并发症.
- 评估微创切除术后同日出院协议的普遍性.
主要方法:
- 美国外科医生学院国家外科质量改进项目 (ACS-NSQIP) 数据库 (2017-2021) 的回顾性分析.
- 包括接受选择性最小侵入性切除术的患者 (≥18岁),但不包括患有严重并发症或住院并发症的患者.
- 1:1的倾向分数匹配,以比较同一天出院和短期逗留组之间的结果.
主要成果:
- 在22,482名患者中,740名 (3.3%) 在同一天出院.
- 倾向性匹配显示30天再录取率 (3.4%与4.7%,P=0.23) 没有显著差异.
- 无显著的差异观察到的解剖间的泄漏 (0.7%对0.8%,P=0.58) 或结肠大肠 (1.4%对1.8%,P=0.58);然而,在SDD组的放出后出血是较高的 (0.5%对0%,P=0.045).
结论:
- 经过最小侵入性切除术后的当日排泄与术后第1或第2天的排泄相比,没有增加再入院,静脉泄漏或手术部位感染.
- 在没有严重的并发症的情况下,可以考虑对精心挑选的患者进行SDD.
- 这项国家研究支持在最小侵入性切除术中更广泛地实施SDD协议.
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