Hebert Kevin J, Joseph Jason, Boswell Timothy, Andrews Jack, Husmann Douglas A, Viers Boyd R
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Transl Androl Urol. 2020 Feb;9(1):23-30. doi: 10.21037/tau.2019.09.10.
Length of stay following anterior urethroplasty (AU) surgery has progressively shortened over the past two decades with most patients discharging the day of surgery or following overnight observation. We sought to assess overall analgesia and patient satisfaction with same-day discharge after AU surgery.
Our prospectively maintained anterior urethroplasty database was reviewed. Men were identified who underwent anterior urethroplasty surgery by a single surgeon (B.R.V.) with the Enhanced Ambulatory Male Urethral Surgery (EAMUS) protocol followed by same-day discharge. Patients were contacted within 3 weeks of surgery and completed validated assessment tools to characterize satisfaction with the outpatient experience and with analgesia management. A statistical analysis was performed to assess predictors of overall satisfaction with same-day discharge following AU surgery.
Fifty-seven patients with median age 52.2 years underwent same-day AU surgery between August 2017 and October 2018. In total, 46 patients (80.7%) responded to post-discharge surveys assessing overall outpatient satisfaction and satisfaction with analgesia. Median satisfaction with outpatient experience (scale 1-5) was 5 (IQR 4, 5) with 93.4% of patients indicating they were satisfied to very satisfied (4 or 5). Median patient satisfaction with analgesia (scale 1-6) was 6 (IQR 5, 6) with 93.4% of patients indicating a satisfaction with analgesia score of ≥5 (satisfied to very satisfied). Median number of 5 mg oxycodone tablets used following discharge was 3 (IQR 0.75, 5). Postoperative complications occurred in 14 patients (25%) with 12 (86%) being low grade complications (Clavien-Dindo Classification ≤ II).
With appropriate preoperative education and peri-operative analgesia, anterior urethroplasty surgery can be performed with same-day discharge with comparable postoperative complication rates while maintaining excellent patient satisfaction. Additional high volume, prospectively collected studies are necessary to verify short-term satisfaction rates while confirming long-term urethroplasty success rates remain comparable to AU surgery performed with next day discharge.
在过去二十年中，前尿道成形术（AU）后的住院时间逐渐缩短，大多数患者在手术当天或经过一夜观察后出院。我们试图评估AU手术后当日出院的总体镇痛效果和患者满意度。
回顾我们前瞻性维护的前尿道成形术数据库。确定了由单一外科医生（B.R.V.）按照强化门诊男性尿道手术（EAMUS）方案进行前尿道成形术手术并当日出院的男性患者。在手术后3周内联系患者，让他们完成经过验证的评估工具，以描述对门诊体验和镇痛管理的满意度。进行统计分析以评估AU手术后当日出院总体满意度的预测因素。
2017年8月至2018年10月期间，57例中位年龄为52.2岁的患者接受了当日AU手术。共有46例患者（80.7%）回复了出院后评估总体门诊满意度和镇痛满意度的调查。门诊体验的中位满意度（1 - 5分制）为5分（四分位间距4，5），93.4%的患者表示他们满意或非常满意（4或5分）。患者对镇痛的中位满意度（1 - 6分制）为6分（四分位间距5，6），93.4%的患者表示镇痛满意度评分≥5分（满意或非常满意）。出院后使用5毫克羟考酮片的中位数量为3片（四分位间距0.75，5）。14例患者（25%）发生术后并发症，其中12例（86%）为低级别并发症（Clavien-Dindo分级≤II级）。
通过适当的术前教育和围手术期镇痛，前尿道成形术手术可以在当日出院的情况下进行，术后并发症发生率相当，同时保持患者的高度满意度。需要进行更多大量的、前瞻性收集的研究，以验证短期满意度，同时确认长期尿道成形术成功率与次日出院的AU手术相当。
