地区综合医院择期“真正日间手术”腹腔镜腹股沟疝修补术：连续1000例病例的经验教训
Elective "True Day Case" Laparoscopic Inguinal Hernia Repair in a District General Hospital: Lessons Learned from 1000 Consecutive Cases.
作者信息
Solodkyy A, Feretis M, Fedotovs A, Di Franco F, Gergely S, Harris A M
机构信息
Department of Upper Gastrointestinal Surgery, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire PE29 6NT, UK.
出版信息
Minim Invasive Surg. 2018 Jun 3;2018:7123754. doi: 10.1155/2018/7123754. eCollection 2018.
INTRODUCTION
Laparoscopic inguinal hernia repair (LIHR) is ideal for day case surgery. It is recommended that at least 70% should be day cases as a measure of cost-effectiveness. The aims of this study were to (i) assess the rate of true day case (TDC) surgery and (ii) identify predictors associated with unexpected overnight stay (UOS).
METHODS
Data was collected prospectively on 1000 consecutive elective LIHR performed in a District General Hospital (DGH) over a 7-year period. Data was collected on baseline patient demographics, ASA grade, and intraoperative details. A multivariate analysis was performed in order to identify predictors of UOS.
RESULTS
1000 patients (927 males) underwent elective LIHR. Mean age was 57.3±15.2 years. 915 patients were planned as day case procedures. 822/915 day cases (89.8%) were discharged on the same day and 93 (10.2%) stayed overnight unexpectedly. Patient age, duration of procedure, and patient slot in the operating list were found to be independent predictors (p<0.05) of UOS.
CONCLUSION
Our results demonstrate that LIHR is a "true" day case procedure in a DGH. Although some factors associated with UOS cannot be altered, careful patient selection and operating list planning are of paramount importance in order to minimise the burden on healthcare resources.
引言
腹腔镜腹股沟疝修补术（LIHR）是日间手术的理想选择。为了衡量成本效益，建议至少70%的手术应为日间手术。本研究的目的是：（i）评估真正日间手术（TDC）的比例；（ii）确定与意外过夜住院（UOS）相关的预测因素。
方法
前瞻性收集了一家地区综合医院（DGH）在7年期间连续进行的1000例择期LIHR手术的数据。收集了患者的基线人口统计学数据、美国麻醉医师协会（ASA）分级以及术中详细信息。进行多因素分析以确定UOS的预测因素。
结果
1000例患者（927例男性）接受了择期LIHR手术。平均年龄为57.3±15.2岁。915例患者计划进行日间手术。915例日间手术患者中，822例（89.8%）在同一天出院，93例（10.2%）意外过夜住院。患者年龄、手术时长以及手术安排表中的患者顺序被发现是UOS的独立预测因素（p<0.05）。
结论
我们的结果表明，在一家地区综合医院中，LIHR是一种“真正的”日间手术。尽管一些与UOS相关的因素无法改变，但仔细的患者选择和手术安排表规划对于最小化医疗资源负担至关重要。
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