From the Department of Obstetrics and Gynecology, Atrium Health, Carolinas Medical Center.
Center for Outcomes Research and Evaluation, Atrium Health, Charlotte.
Female Pelvic Med Reconstr Surg. 2021 Dec 1;27(12):740-745. doi: 10.1097/SPV.0000000000001043.
The objective of this study was to evaluate whether an enhanced recovery after surgery (ERAS) protocol was associated with a higher rate of same-day discharge after robot-assisted or laparoscopic sacrocolpopexy and to describe the safety and feasibility of same-day discharge after these procedures.
A historical control, retrospective cohort study of women undergoing minimally invasive sacrocolpopexy comparing rates of same-day discharge before and after implementation of an ERAS protocol was conducted. Secondary outcomes were obtained by comparing women discharged the same day with those discharged postoperative day ≥1, including postoperative complications and unplanned postoperative patient encounters within 30 days of surgery. Logistic regression was performed to control for potential confounders.
Of the 166 women identified (83 before ERAS implementation; 83 after ERAS implementation), 43 underwent same-day discharge versus 123 admitted overnight. The rate of same-day discharge increased 28 percentage points after ERAS implementation (12% vs 40%, P < 0.01). Compared with women admitted overnight, same-day discharge women had shorter procedures (154 vs 173 minutes, P = 0.01), spent longer time in the postanesthesia care unit (130 vs 106 minutes, P = 0.01), and were more likely to be discharged with a Foley catheter (58% vs 28%, P < 0.01). After multivariable logistic regression analysis, ERAS was associated with increased odds of same-day discharge (odds ratio, 4.91; 95% confidence interval, 2.17-11.09). There were no differences in unplanned postoperative patient contacts or postoperative complications within 30 days between same-day discharge and overnight admission groups.
Implementation of an ERAS protocol for minimally invasive sacrocolpopexy was associated with a 3-fold increase in same-day discharge.
本研究旨在评估加速康复外科（ERAS）方案是否与机器人辅助或腹腔镜骶骨阴道固定术后当天出院率的提高相关，并描述这些手术后当天出院的安全性和可行性。
对行微创骶骨阴道固定术的女性进行历史对照、回顾性队列研究，比较实施 ERAS 方案前后当天出院率。通过比较当天出院和术后住院≥1 天的女性，获得次要结局，包括术后并发症和术后 30 天内计划外患者就诊。采用逻辑回归控制潜在混杂因素。
共纳入 166 例女性（ERAS 实施前 83 例，ERAS 实施后 83 例），43 例当天出院，123 例住院过夜。ERAS 实施后当天出院率提高了 28 个百分点（12% vs 40%，P<0.01）。与住院过夜的女性相比，当天出院的女性手术时间更短（154 分钟 vs 173 分钟，P=0.01），在麻醉后恢复室停留时间更长（130 分钟 vs 106 分钟，P=0.01），且更有可能带 Foley 导管出院（58% vs 28%，P<0.01）。多变量逻辑回归分析后，ERAS 与当天出院的可能性增加相关（优势比，4.91；95%置信区间，2.17-11.09）。当天出院组和住院过夜组在术后 30 天内计划外患者就诊或术后并发症方面无差异。
微创骶骨阴道固定术实施 ERAS 方案可使当天出院率提高 3 倍。
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