Olasehinde Olalekan, Alatise Olusegun, Arowolo Olukayode, Adisa Adewale, Wuraola Funmilola, Boutin-Foster Carla, Lawal Oladejo, Kingham Thomas
Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
J Surg Oncol. 2018 Nov;118(6):861-866. doi: 10.1002/jso.25215. Epub 2018 Oct 7.
Early postmastectomy discharge with a drain in place is standard practice in most developed countries. Its feasibility has not been evaluated in low resource settings like Nigeria.
Consenting patients undergoing mastectomy were discharged on the third postoperative day and assessed as outpatients for wound complications as well as their experience at home. Wound outcomes were compared with patients who had traditional long stay.
Forty-five of the 58 patients who had a mastectomy during the study period participated in the early discharge program (77.6%). Of these, four patients (8.9%) had drain malfunction, seroma occurred in eight patients (17.8%), eight patients (17.8%) had wound infection, and six patients (13.3%) had flap necrosis. There was no readmission. Compared with long stay patients, postoperative stay was significantly shorter (3 vs 11 days; P < 0.01) with significant cost savings, while complication rates were not statistically different. All the patients in the early discharge group were confident operating their drains and preferred early discharge. Being around relatives, reduced cost, and fear of the hospital environment were common reasons cited for their preference.
Our results support the implementation of an early postmastectomy discharge program in a low resource setting.
在大多数发达国家，乳房切除术后早期带引流管出院是标准做法。其可行性尚未在尼日利亚等资源匮乏地区得到评估。
同意参与的乳房切除术患者在术后第三天出院，并作为门诊患者接受伤口并发症评估以及了解他们在家中的情况。将伤口结果与接受传统长期住院治疗的患者进行比较。
在研究期间接受乳房切除术的58名患者中有45名（77.6%）参与了早期出院计划。其中，4名患者（8.9%）出现引流管故障，8名患者（17.8%）发生血清肿，8名患者（17.8%）出现伤口感染，6名患者（13.3%）出现皮瓣坏死。没有患者再次入院。与长期住院患者相比，术后住院时间显著缩短（3天对11天；P < 0.01），成本显著节省，而并发症发生率无统计学差异。早期出院组的所有患者都有信心自行操作引流管，并倾向于早期出院。与亲人在一起、成本降低以及对医院环境的恐惧是他们表示倾向的常见原因。
我们的结果支持在资源匮乏地区实施乳房切除术后早期出院计划。
