Philp Lauren, Covens Allan, Vicus Danielle, Kupets Rachel, Pulman Katherine, Gien Lilian T
Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Gynecol Oncol. 2017 Dec;147(3):572-576. doi: 10.1016/j.ygyno.2017.09.026. Epub 2017 Sep 29.
To evaluate the safety and feasibility of same day-discharge (SDD) after laparoscopic radical hysterectomy for cervix cancer by determining complication rates and factors associated with post-operative admission.
In this retrospective cohort study, patients undergoing laparoscopic radical hysterectomy for cervix cancer at a single institution from January 2006 to November 2015 were identified. Admitted patients were compared to same-day discharge patients. Rates of post-operative complications and readmission were analyzed and regression analysis used to determine factors associated with admission.
119 patients were identified. 75 (63%) were SDD patients (mean stay 156.7±50.2min) and 44 (37%) were admitted patients (mean stay 1.2±0.6days). Ten (13%) SDD patients sought medical attention within 30days post-operatively vs. nine (20%) admitted patients (p=0.17). Reasons SDD patients sought attention included pain (n=1), wound concerns (n=2), vaginal bleeding (n=2), DVT/VTE (n=1), fever (n=2) and fistula (n=2). All patients developed symptoms and presented between 5 and 13days post-operatively thus no complications could have been detected or prevented through initial admission. Four SDD patients were readmitted within 30days of surgery (p=0.25), two required re-operation (p=0.16). Admitted patients were older (p=0.049), had longer operations (p=0.02), increased blood loss (p=0.0004), increased intra-operative complications (p=0.001), surgery later in the day (p=0.004) and before April 2010 (p=0.001). On multivariate analysis, older age (OR1.05, p=0.03), surgery later in the day (OR 7.22, p=0.002) and presence of an intra-operative complication (OR 10.25, p=0.02) were significantly associated with admission.
Same-day discharge after laparoscopic radical hysterectomy for cervix cancer is safe, with a low risk of post-operative morbidity and hospital readmission.
通过确定并发症发生率及与术后再次入院相关的因素，评估宫颈癌腹腔镜根治术后当日出院（SDD）的安全性和可行性。
在这项回顾性队列研究中，确定了2006年1月至2015年11月在单一机构接受宫颈癌腹腔镜根治术的患者。将入院患者与当日出院患者进行比较。分析术后并发症和再入院率，并采用回归分析确定与入院相关的因素。
共确定119例患者。75例（63%）为当日出院患者（平均住院时间156.7±50.2分钟），44例（37%）为入院患者（平均住院时间1.2±0.6天）。10例（13%）当日出院患者在术后30天内寻求医疗护理，而9例（20%）入院患者（p=0.17）。当日出院患者寻求医疗护理的原因包括疼痛（n=1）、伤口问题（n=2）、阴道出血（n=2）、深静脉血栓形成/静脉血栓栓塞（n=1）、发热（n=2）和瘘管（n=2）。所有患者均出现症状并在术后5至13天就诊，因此通过最初入院无法检测或预防任何并发症。4例当日出院患者在术后30天内再次入院（p=0.25），2例需要再次手术（p=0.16）。入院患者年龄较大（p=0.049）、手术时间较长（p=0.02）失血量增加（p=0.0004）、术中并发症增加（p=0.001）、手术在当天较晚时间进行（p=0.004）以及在2010年4月之前进行手术（p=0.001）。多因素分析显示，年龄较大（OR1.05，p=0.03）、手术在当天较晚时间进行（OR 7.22，p=0.002）和存在术中并发症（OR 10.25，p=0.02）与入院显著相关。
宫颈癌腹腔镜根治术后当日出院是安全的，术后发病率和再次入院风险较低。
