Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
Steinberg-Bernstein Center for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
Ann Surg. 2022 Dec 1;276(6):e812-e818. doi: 10.1097/SLA.0000000000004962. Epub 2021 Jun 2.
To investigate the feasibility of SDD protocol with postdischarge follow-up using a mobile phone app in patients undergoing elective minimally-invasive colectomy.
Discharge before gastrointestinal recovery and use of mobile health technology for remote follow-up may allow for SDD after minimally-invasive colectomy within an ERP.
Adult patients undergoing elective laparoscopic colectomy or loop ileostomy reversal from February 2020 to November 2020 were screened for eligibility. Patients were eligible if they lived within a 30-minute drive from the hospital, had an adequate support system at home, and owned a smart phone. Patients were discharged from the recovery room on the day of surgery based on set criteria with postdischarge remote follow-up using a mobile application. Feasibility was defined as discharge on the day of surgery without emergency department (ED) visit or readmission within the first 3 days. 30-day complications, ED visits, and readmissions were compared to a non-SDD historical cohort (May 2019-March 2020) also remotely followed-up using the same mobile phone app (standard ERP group).
A total of 48 patients were recruited to SDD, of which 77% were discharged on the day of surgery without subsequent ED visit in the first 72 hours. There were 11 patients that could not be discharged, including 7 for failure of discharge criteria and 4 for intraoperative complications/concerns. Overall 30-day complications in the SDD group (17%) was similar to the standard ERP group (15%, P = 0.813). ED visits (SDD10% vs standard ERP8%, P = 0.664) and readmissions (6% vs 4%, P = 0.681) were also similar.
Findings from this study support the feasibility of a SDD protocol in select patients undergoing minimally-invasive colorectal resection. SDD colectomy protocols may represent the next evolution of ERP and postoperative recovery.
研究在接受择期微创结肠切除术的患者中使用移动电话应用程序进行出院后随访的 SDD 方案的可行性。
在微创结肠切除术后胃肠道恢复前出院并使用移动健康技术进行远程随访，可能允许在 ERP 内进行 SDD。
筛选 2020 年 2 月至 2020 年 11 月期间接受择期腹腔镜结肠切除术或回路回肠造口术反转的成年患者是否符合入选条件。如果患者居住在距离医院 30 分钟车程内、家中有足够的支持系统且拥有智能手机，则符合入选条件。患者根据设定标准在手术当天从恢复室出院，并使用移动应用程序进行出院后远程随访。可行性定义为在手术当天出院，且在出院后 72 小时内无需前往急诊部（ED）就诊或再次入院。将 30 天并发症、ED 就诊次数和再次入院情况与使用相同移动电话应用程序（标准 ERP 组）进行远程随访的非 SDD 历史队列（2019 年 5 月至 2020 年 3 月）进行比较。
共纳入 48 例 SDD 患者，其中 77%的患者在手术当天出院，且在出院后 72 小时内无后续 ED 就诊。有 11 例患者不能出院，包括 7 例因不符合出院标准和 4 例因术中并发症/问题。SDD 组（17%）和标准 ERP 组（15%，P = 0.813）的 30 天总体并发症发生率相似。ED 就诊（SDD10%比标准 ERP8%，P = 0.664）和再次入院（6%比 4%，P = 0.681）也相似。
本研究结果支持在接受微创结直肠切除术的特定患者中实施 SDD 方案的可行性。SDD 结肠切除术方案可能代表 ERP 和术后恢复的下一个发展阶段。
