Kruse J R, Cragg A H
Minneapolis Vascular Institute, Edina, MN 55435, USA.
J Vasc Interv Radiol. 2000 Jan;11(1):45-9. doi: 10.1016/s1051-0443(07)61277-9.
To determine whether short observation periods (less than or equal to 4 hours) are safe in outpatients undergoing arterial peripheral vascular interventions.
A retrospective review of 203 patient medical records from the Interventional Vascular Department for 239 lower extremity or abdominal procedures (161 men and 78 women) during a 5-year period was completed. The average patient age was 62.2 years (range, 32-83 years). Thirty-six patients had more than one procedure. Indication, intervention, coagulation status, complication rate, and hospitalizations within 7 days after discharge from the short stay unit (SSU) were reviewed and the outcome was measured. Patients were grouped according to the length of their observation period (< or =4 hours or >4 hours) for statistical analysis.
In 85% of the procedures (204 procedures), claudication was the primary indication for intervention. Angioplasty (203 procedures) was also commonly performed. Ninety procedures (38%) required stent placement, and other interventional procedures performed were pulse-spray thrombolysis (eight procedures), atherectomy (two procedures), and stent-graft placement (one procedure). None of the patients required hospitalization as a result of their radiologic intervention within 7 days after discharge from the SSU. Specifically, there were no major "at home" complications in patients discharged after an observation period of < or =4 hours. Two patients were admitted for outpatient procedures and were subsequently hospitalized as a result of a complication from the procedure. The complication rate (including minor complications) was 8% (seven of 87) in the < or =4 hour observation period group compared with 24.3% (37 of 152) in the >4 hour group (P < .01). This difference was due to a greater number of minor hematomas in the >4 hour group.
Based on the authors' findings, many interventional vascular procedures can be performed safely on an outpatient basis with relatively short observation times. Early discharge from the SSU did not result in an increased readmission rate to the hospital because of delayed complications.
确定在接受动脉外周血管介入治疗的门诊患者中，短观察期（小于或等于4小时）是否安全。
对介入血管科5年内203例患者的239例下肢或腹部手术（161例男性，78例女性）的病历进行回顾性研究。患者平均年龄为62.2岁（范围32 - 83岁）。36例患者接受了不止一次手术。对适应证、干预措施、凝血状态、并发症发生率以及从短期住院病房（SSU）出院后7天内的住院情况进行回顾，并对结果进行测量。根据观察期长短（小于或等于4小时或大于4小时）对患者进行分组以进行统计分析。
在85%的手术（204例）中，间歇性跛行是干预的主要适应证。血管成形术（203例）也较为常见。90例（38%）需要放置支架，其他进行的介入手术包括脉冲喷射溶栓（8例）、旋切术（2例）和支架移植物置入（1例）。从SSU出院后7天内，没有患者因放射介入治疗而需要住院。具体而言，观察期小于或等于4小时后出院的患者没有出现重大“在家”并发症。两名患者因门诊手术入院，随后因手术并发症而住院。小于或等于4小时观察期组的并发症发生率（包括轻微并发症）为8%（87例中的7例），而大于4小时组为24.3%（152例中的37例）（P < .01）。这种差异是由于大于4小时组中轻微血肿的数量较多。
基于作者的研究结果，许多介入血管手术在门诊进行时，观察时间相对较短也可安全实施。从SSU提前出院并未因延迟并发症导致医院再入院率增加。
