Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Gynecol Oncol. 2014 Jun;133(3):552-5. doi: 10.1016/j.ygyno.2014.04.006. Epub 2014 Apr 13.
This study aimed to report the feasibility and safety of same-day discharge after robotic-assisted hysterectomy.
Same-day discharge after robotic-assisted hysterectomy was initiated 07/2010. All cases from then through 12/2012 were captured for quality assessment monitoring. The distance from the hospital to patients' homes was determined using http://maps.google.com. Procedures were categorized as simple (TLH+/-BSO) or complex (TLH+/-BSO with sentinel node mapping, pelvic and/or aortic nodal dissection, appendectomy, or omentectomy). Urgent care center (UCC) visits and readmissions within 30days of surgery were captured, and time to the visit was determined from the initial surgical date.
Same-day discharge was planned in 200 cases. Median age was 52years (range, 30-78), BMI was 26.8kg/m(2) (range, 17.4-56.8), and ASA was class 2 (range, 1-3). Median distance traveled was 31.5miles (range, 0.2-149). Procedures were simple in 109 (55%) and complex in 91 (45%) cases. The indication for surgery was: endometrial cancer (n=82; 41%), ovarian cancer (n=5; 2.5%), cervical cancer (n=8; 4%), and non-gynecologic cancer/benign (n=105; 53%). One hundred fifty-seven (78%) had successful same-day discharge. Median time for discharge for these cases was 4.8h (range, 2.4-10.3). Operative time, case ending before 6pm, and use of intraoperative ketorolac were associated with successful same-day discharge. UCC visits occurred in 8/157 (5.1%) same-day discharge cases compared to 5/43 (11.6%) requiring admission (P=.08). Readmission was necessary in 4/157 (2.5%) same-day discharge cases compared to 3/43 (7.0%) requiring admission (P=.02).
Same-day discharge after robotic-assisted hysterectomy for benign and malignant conditions is feasible and safe.
本研究旨在报告机器人辅助子宫切除术后当天出院的可行性和安全性。
自 2010 年 7 月起开始实施机器人辅助子宫切除术当天出院。对所有 2010 年 7 月至 2012 年 12 月期间的病例进行质量评估监测。使用 http://maps.google.com 确定医院到患者家的距离。手术分为简单（TLH +/- BSO）或复杂（TLH +/- BSO 加前哨淋巴结映射、盆腔和/或主动脉淋巴结清扫术、阑尾切除术或网膜切除术）。记录术后 30 天内紧急护理中心（UCC）就诊和再入院情况，并从初次手术日期开始计算就诊时间。
计划 200 例患者当天出院。中位年龄为 52 岁（范围 30-78 岁），BMI 为 26.8kg/m²（范围 17.4-56.8），ASA 分级为 2 级（范围 1-3 级）。中位旅行距离为 31.5 英里（范围 0.2-149 英里）。109 例（55%）为简单手术，91 例（45%）为复杂手术。手术指征为：子宫内膜癌（n=82；41%）、卵巢癌（n=5；2.5%）、宫颈癌（n=8；4%）和非妇科癌症/良性肿瘤（n=105；53%）。157 例（78%）患者成功当天出院。这些患者的中位出院时间为 4.8 小时（范围 2.4-10.3 小时）。手术时间、下午 6 点前结束手术和术中使用酮咯酸与当天成功出院相关。在 157 例当天出院的患者中，有 8 例（5.1%）到 UCC 就诊，而需住院的 43 例患者中有 5 例（11.6%）就诊（P=.08）。157 例当天出院患者中有 4 例（2.5%）需要再次入院，而需住院的 43 例患者中有 3 例（7.0%）需要再次入院（P=.02）。
机器人辅助子宫切除术治疗良性和恶性疾病后当天出院是可行且安全的。
