Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA.
Department of Surgery, University of Chicago Medical Center, Chicago, USA.
Surg Endosc. 2021 Jul;35(7):3971-3980. doi: 10.1007/s00464-020-07866-0. Epub 2020 Aug 11.
Although peroral endoscopic myotomy (POEM) has emerged as a highly efficacious procedure in the treatment of a variety of esophageal motility disorders, currently no standard pathway for postprocedural care exists. Our study aims to report institutional outcomes in performing POEM as an outpatient procedure with same-day discharge. Additionally, we seek to determine factors associated with admission.
Demographic, perioperative, and postoperative outcome data of 115 patients who underwent POEM between June 2014 and January 2020 on a same-day discharge pathway were analyzed. Cohorts were compared using the t test, Wilcoxon rank-sum, or chi-square test. Multivariable logistic regression with a manual backward selection method was used to identify factors associated with admission.
Fifty-five patients (48%) were successfully discharged same-day. The most common primary reasons for admission were delay in obtaining an esophagram (25%), intraoperative complication (13.3%), and pain (10%). There were no differences in 30-day ED visit rate (12.7% vs 15.0%, p = 0.725) or 30-day readmission rate (9.1% vs 16.7%, p = 0.373) between patients who were discharged same-day versus patients who were admitted. Patients discharged same-day had fewer intraoperative complications (1 vs 9, p = 0.017), shorter OR time (69 vs 100 min, p < 0.001), and earlier cessation of narcotic use (day 0 vs day 1, p = 0.001). On multivariable analysis, intraoperative complication (p = 0.048) was associated with overnight admission.
Patients did not experience additional morbidity with same-day discharge after POEM. A delay in obtaining an esophagram was the most common reason that patients were admitted and those who suffered an intraoperative complication are more likely to require admission.
经口内镜下肌切开术（POEM）已成为治疗多种食管动力障碍的有效方法，但目前尚无术后护理的标准流程。我们旨在报告行 POEM 作为门诊手术并实现当日出院的机构结果。此外，我们还试图确定与住院相关的因素。
分析了 2014 年 6 月至 2020 年 1 月期间 115 例行 POEM 手术的患者的人口统计学、围手术期和术后结果数据。使用 t 检验、Wilcoxon 秩和检验或卡方检验比较队列。使用手动向后选择方法的多变量逻辑回归用于确定与住院相关的因素。
55 例（48%）患者成功当日出院。最常见的住院主要原因是延迟获得食管造影（25%）、术中并发症（13.3%）和疼痛（10%）。当日出院患者与住院患者的 30 天 ED 就诊率（12.7% vs 15.0%，p=0.725）或 30 天再入院率（9.1% vs 16.7%，p=0.373）无差异。当日出院患者术中并发症更少（1 例 vs 9 例，p=0.017）、手术时间更短（69 分钟 vs 100 分钟，p<0.001）、阿片类药物停用时间更早（第 0 天 vs 第 1 天，p=0.001）。多变量分析显示，术中并发症（p=0.048）与住院相关。
POEM 后当日出院患者并未出现额外的发病率。延迟获得食管造影是患者住院的最常见原因，术中并发症患者更有可能需要住院。
