Department of Surgical Gynecology (Drs. DeStephano, Gajarawala, Espinal, and Robertson).
Department of Surgical Gynecology (Drs. DeStephano, Gajarawala, Espinal, and Robertson).
J Minim Invasive Gynecol. 2019 Jul-Aug;26(5):910-918. doi: 10.1016/j.jmig.2018.09.766. Epub 2018 Sep 18.
To evaluate which factors may be predictive of patient readiness of discharge after robotic and laparoscopic hysterectomy.
A prospective cohort study (Canadian Task Force classification II-2).
A single tertiary care center in the United States.
All 230 patients undergoing robotic and laparoscopic hysterectomy between November 2015 and April 2017.
The primary outcome measure was whether or not the patient felt ready for discharge when she was sent home, and this was assessed using a survey 4 to 6 weeks after surgery. Secondary outcomes included the number of postoperative phone calls, 30-day readmission, and also whether the patient felt knowledgeable about postoperative symptoms and restrictions (both assessed via a 4- to 6-week survey). Associations of baseline, operative, and postoperative characteristics with outcomes were evaluated using regression models appropriate for the nature of the given outcome measure.
Of the 230 patients, 207 (90%) reported they felt ready for discharge on the postoperative survey. The majority of patients strongly agreed that they felt knowledgeable about what symptoms to expect postoperatively (60%) and about postoperative restrictions (71%). The median number of postoperative phone calls was 1 (range, 0-11), with 104 patients (45%) having more than 1 postoperative call. The only factor that was significantly associated with a lack of readiness for discharge was a longer total operating room time (p = .011). Factors associated with more postoperative phone calls were a urogynecologic indication (p = .005), a cancer indication (p = .024), a longer total operative room time (p = .014), a postoperative complication (p <.001), and not seeing a patient education video (p = .018). Knowledge of postoperative restrictions was significantly worse for older patients (p = .004) and varied significantly according to surgeon (p = .038). No significant predictors of knowledge of postoperative symptoms were identified.
Discharge readiness and knowledge of postoperative restrictions and symptoms were high in patients who underwent laparoscopic and robotic hysterectomies. The risk factors for outcomes that were identified highlight groups of patients who can be targeted for preemptive interventions both preoperatively and postoperatively.
评估哪些因素可能与机器人辅助腹腔镜子宫切除术患者出院准备情况相关。
前瞻性队列研究（加拿大任务组分类 II-2）。
美国的一家单一的三级护理中心。
2015 年 11 月至 2017 年 4 月期间接受机器人辅助腹腔镜子宫切除术的 230 名患者。
主要结局指标为患者在出院时是否感到准备就绪，这是通过术后 4 至 6 周的调查评估的。次要结局包括术后电话随访次数、30 天再入院率，以及患者对术后症状和限制的了解程度（均通过术后 4 至 6 周的调查评估）。使用适合给定结局测量的回归模型评估基线、手术和术后特征与结局的关联。
在 230 名患者中，207 名（90%）在术后调查中报告他们感到准备出院。大多数患者强烈同意他们对术后预期症状（60%）和术后限制（71%）有足够的了解。术后电话随访中位数为 1 次（范围，0-11 次），104 名患者（45%）有超过 1 次术后电话随访。唯一与出院准备不足显著相关的因素是总手术室时间较长（p=0.011）。与术后电话随访次数较多相关的因素包括尿妇科指征（p=0.005）、癌症指征（p=0.024）、总手术时间较长（p=0.014）、术后并发症（p<0.001）和未观看患者教育视频（p=0.018）。老年患者的术后限制知识明显较差（p=0.004），且根据手术医生的不同差异显著（p=0.038）。未发现与术后症状知识显著相关的预测因素。
接受腹腔镜和机器人子宫切除术的患者出院准备情况和对术后限制及症状的了解程度较高。确定的结局风险因素突出了可以在术前和术后针对特定患者群体进行预防性干预的人群。
