Bednar Drew A
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Spine (Phila Pa 1976). 2017 Jul 15;42(14):E871-E875. doi: 10.1097/BRS.0000000000001987.
This is a prospective cohort study.
The aim of this study was to define the probability of successful morning-after discharge after adult spine surgery achieved with a standard care protocol as applied to patients with a large variety of common degenerative spine disorders.
Qualifying criteria for ambulatory or overnight-stay adult spine surgery are not well defined in either the spine or anesthesia literature. Most reports simply go to American Society of Anesthesiology risk classification or surgical technique alternatives and do not present a clearly defined patient care and case management protocol.
A standardized protocol of patient preparation, preoperative comorbidities optimization, and perioperative care was applied in a prospective cohort of 126 patients including 83 lumbar and 41 cervical procedures. Office and hospital chart records were reviewed for relevant outcomes.
Fully 122 of 124 appropriately selected cases were able to successfully achieve uneventful same-day discharge without any need for readmission, unscheduled early emergency room or clinic visits, or other major complications. Both failures were for urinary retention in senior males and resolved after a single-day admission to the main hospital.
A wide variety of common degenerative spinal pathology in adults can be routinely and safely managed on an overnight-stay basis without requirement for formal hospital inpatient admission in patients appropriately selected and pre-educated to the experience and whose major comorbidities are preoperatively optimized.
N/A.
这是一项前瞻性队列研究。
本研究旨在确定在应用标准护理方案对患有多种常见退行性脊柱疾病的患者进行成人脊柱手术后，次日清晨成功出院的概率。
脊柱或麻醉文献中均未明确界定成人日间或过夜脊柱手术的合格标准。大多数报告仅提及美国麻醉医师协会风险分类或手术技术选择，并未提出明确界定的患者护理和病例管理方案。
对126例患者（包括83例腰椎手术和41例颈椎手术）的前瞻性队列应用标准化的患者准备、术前合并症优化及围手术期护理方案。查阅门诊和医院病历记录以获取相关结果。
124例适当选择的病例中有122例能够成功实现当日平稳出院，无需再次入院、非计划的早期急诊室或门诊就诊，或出现其他重大并发症。两例失败病例均为老年男性尿潴留，在入住主医院一天后得到解决。
对于适当选择并接受过该经验预教育且主要合并症在术前得到优化的患者，多种常见的成人退行性脊柱病变可在过夜基础上常规且安全地处理，无需正式住院。
无。
