From the Department of Surgery, University of Toronto, Toronto, Ont. (Jacob-Brassard, Al-Omran, Salata, Hussain, Kayssi, Roche-Nagle); the Li Ka Shing Knowledge Institute of St. Michaels Hospital, Toronto, Ont. (Al-Omran, Salata, Hussain, de Mestral); the Sunnybrook Research Institute of Sunnybrook Health Sciences Centre, Toronto, Ont. (Kayssi); and the Peter Munk Cardiac Center of the University Health Network, Toronto, Ont. (Roche-Nagle).
Can J Surg. 2021 Mar 5;64(2):E149-E154. doi: 10.1503/cjs.001220.
Recent evidence suggests that home care nursing is variably prescribed after vascular surgery, and may reduce emergency department visits and hospital readmissions. We therefore sought to characterize the indications for home care nursing following vascular surgery from the surgeon's perspective.
An online survey was distributed to the 141 members of the Canadian Society for Vascular Surgery with questions related to home care nursing after carotid endarterectomy (CEA), endovascular aortic aneurysm repair (EVAR), open abdominal aortic aneurysm (AAA) repair and open or hybrid revascularization for peripheral arterial disease (PAD). We included all questionnaires in our analysis; the frequency denominator changes according to the number of respondents who completed each survey item.
There were 46 survey respondents (33% of 141) from across the country. A total of 28 (62% of 45) worked in a teaching hospital. Home care nursing was routinely prescribed by 5%, 10%, 31% and 41% of respondents following CEA, EVAR, open AAA repair and open or hybrid revascularization for PAD, respectively. Across all procedure types, the same procedure-related criteria were most often deemed to warrant a prescription for home care nursing: surgical site infection, wound complications (e.g., open wound, lymphatic leak) and use of negative-pressure wound therapy. Across all procedure types, lack of social support, physical frailty and cognitive impairment were most frequently identified as patient-specific considerations for prescribing home care nursing. Few respondents reported restrictions or standards that informed their prescribing practice.
Most surgeon respondents agreed on the indications for home care nursing after vascular surgery. However, evidence-based standards to guide patient selection for home care nursing after vascular surgery are needed.
最近的证据表明，血管手术后家庭护理的规定各不相同，这可能会减少急诊就诊次数和医院再入院率。因此，我们试图从外科医生的角度描述血管手术后家庭护理的指征。
我们向加拿大血管外科学会的 141 名成员发放了一份在线调查，内容涉及颈动脉内膜切除术 (CEA)、血管内主动脉瘤修复术 (EVAR)、开放性腹主动脉瘤修复术和外周动脉疾病 (PAD) 的开放或杂交血运重建术后的家庭护理。我们将所有问卷都包括在分析中；由于每个调查项目的完成者人数不同，因此频率分母会发生变化。
来自全国各地的 46 名调查员（141 名中的 33%）参与了调查。共有 28 人（45 人的 62%）在教学医院工作。分别有 5%、10%、31%和 41%的受访者在 CEA、EVAR、开放性 AAA 修复术和 PAD 的开放或杂交血运重建术后常规开处家庭护理处方。在所有手术类型中，相同的与手术相关的标准通常被认为是开具家庭护理处方的指征：手术部位感染、伤口并发症（如开放性伤口、淋巴漏）和使用负压伤口治疗。在所有手术类型中，缺乏社会支持、身体虚弱和认知障碍是最常被认为是开具家庭护理处方的患者特定考虑因素。很少有受访者报告说有任何限制或标准来指导他们的处方实践。
大多数外科医生受访者都同意血管手术后家庭护理的指征。然而，需要有循证标准来指导血管手术后家庭护理患者的选择。
