Moss G
Arch Surg. 1986 Oct;121(10):1159-61. doi: 10.1001/archsurg.1986.01400100067013.
Discharge with 24 hours of elective cholecystectomy has proved to be an attainable goal for the vast majority of patients, without increasing risk. The clinical courses of the first 100 subjects (of 109 consecutive patients) to reach this goal were examined critically. Preservation of gastrointestinal function and immediate full enteral nutrition were major steps toward reduction of hospital dependency. Pain and the need for narcotics were reduced by careful patient instruction and wound infiltration with a long-acting local anesthetic. Preoperative hospitalization was eliminated by outpatient testing and admission for 29 subjects, who were admitted the day of surgery. This group's entire stay was only one day. Patients and family found the total regimen acceptable by independent review. Significant cost savings were realized as a fringe benefit.
事实证明，对于绝大多数患者而言，在择期胆囊切除术后24小时内出院是一个可以实现的目标，且不会增加风险。我们严格审查了连续109例患者中率先实现这一目标的前100例患者的临床病程。保持胃肠功能以及立即进行全肠内营养是减少对医院依赖的主要措施。通过对患者进行仔细指导以及用长效局部麻醉剂浸润伤口，疼痛和对麻醉剂的需求得以减轻。通过门诊检查以及29例患者在手术当天入院，避免了术前住院。该组患者的总住院时间仅为一天。经独立评估，患者及其家属认为整个治疗方案是可以接受的。作为一项额外收获，还实现了显著的成本节约。
