Ramshaw Bruce, Dean Jonathan, Forman Brandie, Heidel Eric, Gamenthaler Andrew, Fabian Michael
Department of Surgery, Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee, USA.
Am Surg. 2016 Aug;82(8):707-12.
The use of closed suction drains in the abdominal wall is a common practice in abdominal wall reconstruction (AWR) operations. Drains can be a conduit for bacteria and can cause pain and discomfort for patients after surgery. A single hernia program has implemented the principles of clinical quality improvement in an attempt to improve outcomes for hernia patients. An attempt at a process improvement was implemented to eliminate the use of drains in AWR by adapting the technique. A total of 102 patients undergoing AWR were included between 8/11 and 9/15 (49 months). Compared with the group before the attempt at eliminating the use of abdominal wall drains (8/11-9/13), the group of patients after the implementation of the attempted process improvement (9/13-9/15) had less wound and pulmonary complications, a shorter hospital stay, less time in the postanesthesia care unit, and less opioid use in the postanesthesia care unit as well as for the entire hospital stay. In this group of AWR patients, an attempt at process improvement that eliminated the use of drains led to improved outcomes. Abdominal wall drains may be able to be safely eliminated with appropriate technique adaptation for AWR.
在腹壁重建（AWR）手术中，在腹壁使用封闭式吸引引流管是一种常见的做法。引流管可能成为细菌的传播途径，并可能在术后给患者带来疼痛和不适。一个单一的疝气治疗项目实施了临床质量改进原则，试图改善疝气患者的治疗效果。通过调整技术，实施了一项流程改进措施，以消除AWR中引流管的使用。在8月11日至9月15日（49个月）期间，共有102例接受AWR的患者被纳入研究。与尝试消除腹壁引流管使用之前的组（8月11日至9月13日）相比，实施尝试性流程改进后的患者组（9月13日至9月15日）伤口和肺部并发症更少，住院时间更短，在麻醉后护理单元的时间更短，在麻醉后护理单元以及整个住院期间使用的阿片类药物更少。在这组AWR患者中，一项消除引流管使用的流程改进尝试带来了更好的治疗效果。通过对AWR进行适当的技术调整，腹壁引流管或许能够被安全地消除。
