Emmanuel A, Chohda E, Botfield C, Ellul J
King's College Hospital NHS Foundation Trust , UK.
Ann R Coll Surg Engl. 2018 Jan;100(1):52-56. doi: 10.1308/rcsann.2017.0149. Epub 2017 Sep 15.
Introduction Short hospital stays and accelerated discharge within 72 hours following colorectal cancer resections have not been widely achieved. Series reporting on accelerated discharge involve heterogeneous patient populations and exclude important groups. Strict adherence to some discharge requirements may lead to delays in discharge. The aim of this study was to evaluate the safety and feasibility of accelerated discharge within 72 hours of all elective colorectal cancer resections using simple discharge criteria. Methods Elective colorectal cancer resections performed between August 2009 and December 2015 by a single surgeon were reviewed. Perioperative care was based on an enhanced recovery programme. A set of simplified discharge criteria were used. Outcomes including postoperative complications, readmissions and reoperations were compared between patients discharged within 72 hours and those with a longer postoperative stay. Results Overall, 256 colorectal cancer resections (90% laparoscopic) were performed. The mean patient age was 70.8 years. The median length of stay was 3 days. Fifty-eight per cent of all patients and sixty-three per cent of patients undergoing laparoscopic surgery were discharged within 72 hours. Accelerated discharge was not associated with adverse outcomes compared with delayed discharge. Patients discharged within 72 hours had significantly fewer postoperative complications, readmissions and reoperations. Open surgery and stoma formation were associated with discharge after 72 hours but not age, co-morbidities, neoadjuvant chemoradiation or surgical procedure. Conclusions Accelerated discharge within 72 hours of elective colorectal resection for cancer is safely achievable for the majority of patients without compromising short-term outcomes.
引言 结直肠癌切除术后短时间住院并在72小时内加速出院尚未广泛实现。关于加速出院的系列报道涉及异质化的患者群体,且排除了重要群体。严格遵守某些出院要求可能导致出院延迟。本研究的目的是使用简单的出院标准评估所有择期结直肠癌切除术后72小时内加速出院的安全性和可行性。
方法 回顾了2009年8月至2015年12月期间由一名外科医生进行的择期结直肠癌切除术。围手术期护理基于强化康复计划。使用了一套简化的出院标准。比较了72小时内出院的患者与术后住院时间较长的患者的术后并发症、再入院和再次手术等结果。
结果 总体而言,共进行了256例结直肠癌切除术(90%为腹腔镜手术)。患者平均年龄为70.8岁。中位住院时间为3天。所有患者中有58%以及接受腹腔镜手术的患者中有63%在72小时内出院。与延迟出院相比,加速出院与不良后果无关。72小时内出院的患者术后并发症、再入院和再次手术的情况明显较少。开放手术和造口形成与72小时后出院有关,但与年龄、合并症、新辅助放化疗或手术方式无关。
结论 对于大多数患者而言,择期结直肠癌切除术后72小时内加速出院是安全可行的,且不影响短期预后。