回肠造口关闭术作为一种日间手术：与国家外科质量改进项目数据集的机构比较。

Loop Ileostomy Closure as an Overnight Procedure: Institutional Comparison With the National Surgical Quality Improvement Project Data Set.

作者信息

Berger Nicholas G, Chou Raymond, Toy Elliot S, Ludwig Kirk A, Ridolfi Timothy J, Peterson Carrie Y

机构信息

Division of Colorectal Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.

出版信息

Dis Colon Rectum. 2017 Aug;60(8):852-859. doi: 10.1097/DCR.0000000000000793.

DOI:10.1097/DCR.0000000000000793

PMID:28682971

Abstract

BACKGROUND

Enhanced recovery pathways have decreased length of stay after colorectal surgery. Loop ileostomy closure remains a challenge, because patients experience high readmission rates, and validation of enhanced recovery pathways has not been demonstrated. This study examined a protocol whereby patients were discharged on the first postoperative day and instructed to advance their diet at home with close telephone follow-up.

OBJECTIVE

The hypothesis was that patients can be safely discharged the day after loop closure, leading to shorter length of stay without increased rates of readmission or complications.

DESIGN

Patients undergoing loop ileostomy closure were queried from the American College of Surgeons National Surgical Quality Improvement Project and compared with a single institution (2012-2015). Length of stay, 30-day readmission, and 30-day morbidity data were analyzed.

SETTINGS

The study was conducted at a tertiary university department.

PATIENTS

The study includes 1602 patients: 1517 from the National Surgical Quality Improvement Project database and 85 from a single institution.

MAIN OUTCOME MEASURES

Length of stay and readmission rates were measured.

RESULTS

Median length of stay was less at the single institution compared with control (2 vs 4 d; p < 0.001). Thirty-day readmission (15.3% vs 10.4%; p = 0.15) and overall 30-day complications (15.3% vs 16.7%; p = 0.73) were similar between cohorts. Estimated adjusted length of stay was less in the single institution (2.93 vs 5.58 d; p < 0.0001). There was no difference in the odds of readmission (p = 0.22).

LIMITATIONS

The main limitations of this study include its retrospective nature and limitations of the National Surgical Quality Improvement Program database.

CONCLUSIONS

Next-day discharge with protocoled diet advancement and telephone follow-up is acceptable after loop ileostomy closure. Patients can benefit from decreased length of stay without an increase in readmission or complications. This has the potential to change the practice of postoperative management of loop ileostomy closure, as well as to decrease cost. See Video Abstract at http://links.lww.com/DCR/A310.

摘要

背景

强化康复方案已缩短了结直肠手术后的住院时间。回肠袢式造口关闭术仍然是一项挑战，因为患者的再入院率很高，且强化康复方案的有效性尚未得到证实。本研究考察了一种方案，即患者在术后第一天出院，并在家中遵循饮食进展指导，同时接受密切的电话随访。

目的

假设是患者在回肠袢式造口关闭术后第一天能够安全出院，从而缩短住院时间，且不会增加再入院率或并发症发生率。

设计

从美国外科医师学会国家外科质量改进项目中查询接受回肠袢式造口关闭术的患者，并与一家单一机构（2012 - 2015年）的患者进行比较。分析住院时间、30天再入院率和30天发病率数据。

设置

本研究在一所大学的三级科室进行。

患者

该研究纳入1602例患者：1517例来自国家外科质量改进项目数据库，85例来自一家单一机构。

主要观察指标

测量住院时间和再入院率。

结果

与对照组相比，单一机构的中位住院时间更短（2天对4天；p < 0.001）。两组之间的30天再入院率（15.3%对10.4%；p = 0.15）和总体30天并发症发生率（15.3%对16.7%；p = 0.73）相似。单一机构的估计调整后住院时间更短（2.93天对5.58天；p < 0.0001）。再入院几率没有差异（p = 0.22）。