Melamed Alexander, Katz Eriksen Jennifer L, Hinchcliff Emily M, Worley Michael J, Berkowitz Ross S, Horowitz Neil S, Muto Michael G, Urman Richard D, Feltmate Colleen M
Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.
Ann Surg Oncol. 2016 Jan;23(1):178-85. doi: 10.1245/s10434-015-4582-4. Epub 2015 May 9.
The aim of this study was to investigate the relationship between same-day discharge (SDD) and postoperative complications within 30 days of laparoscopic hysterectomy for endometrial cancer and endometrial intraepithelial neoplasia (EIN).
This single-institution retrospective cohort included all patients who underwent conventional and robotic-assisted laparoscopic hysterectomy for endometrial cancer or EIN in a large teaching hospital between 2011 and 2013. Temporal trends in frequency of SDD and rates of postoperative complications were investigated to assess whether adoption of routine SDD was associated with increased postoperative complications. Associations between SDD and postoperative complications were also investigated in univariate and multivariate models.
Overall, 696 patients underwent laparoscopic hysterectomy. Of these, 37.1 % had pelvic lymphadenectomy, 3.0 % had para-aortic lymphadenectomy, and 9.3 % underwent omentectomy. The rate of SDD increased from 3.9 to 69.6 % during the study period (p < 0.001), and the frequency of postoperative readmission, unscheduled surgery, infection, and composite complications within 30 days of hysterectomy did not differ during the study period. The composite complication rate did not differ significantly between patients who underwent surgery before and after the adoption of routine SDD (rate ratio 0.7, 95 % CI 0.4-1.2, p = 0.24). After controlling for demographic, intraoperative, and comorbid factors, patients who underwent SDD were not at increased risk for postoperative complications.
Adoption of routine SDD after laparoscopic surgery for endometrial cancer and EIN did not result in increased complication rates within our institution. A larger prospective study is required to definitively establish the safety of this approach.
本研究旨在探讨子宫内膜癌及子宫内膜上皮内瘤变（EIN）行腹腔镜子宫切除术后当日出院（SDD）与30天内术后并发症之间的关系。
本单机构回顾性队列研究纳入了2011年至2013年期间在一家大型教学医院接受传统及机器人辅助腹腔镜子宫切除术治疗子宫内膜癌或EIN的所有患者。研究SDD频率的时间趋势及术后并发症发生率，以评估采用常规SDD是否与术后并发症增加相关。还在单因素和多因素模型中研究了SDD与术后并发症之间的关联。
总体而言，696例患者接受了腹腔镜子宫切除术。其中，37.1%的患者进行了盆腔淋巴结清扫术，3.0%的患者进行了腹主动脉旁淋巴结清扫术，9.3%的患者进行了大网膜切除术。在研究期间，SDD率从3.9%增至69.6%（p<0.001），子宫切除术后30天内再次入院、非计划手术、感染及复合并发症的频率在研究期间无差异。在采用常规SDD之前和之后接受手术的患者之间，复合并发症发生率无显著差异（率比0.7，95%CI 0.4 - 1.2，p = 0.24）。在控制了人口统计学、术中及合并症因素后，接受SDD的患者术后并发症风险并未增加。
在我们机构中，子宫内膜癌及EIN行腹腔镜手术后采用常规SDD并未导致并发症发生率增加。需要进行更大规模的前瞻性研究来明确确定这种方法的安全性。
