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脑肿瘤切除术后当日出院:一项前瞻性试点研究。

Same-day discharge after brain tumor resection: a prospective pilot study.

机构信息

Department of Neurosurgery, University of Miami Miller School of Medicine Lois Pope Life Center, 1095 14th Terrace, Miami, FL, 33136, USA.

出版信息

J Neurooncol. 2022 Apr;157(2):345-353. doi: 10.1007/s11060-022-03969-x. Epub 2022 Feb 22.

Abstract

PURPOSE

Outpatient brain surgery has many advantages for the psychological and physical wellbeing of patients, as well as reduced costs to the health care system. Compared with inpatient admissions, same day discharges reduce patient exposure to nosocomial infection, thromboembolic complications, and medical error. We aim to establish a prospectively collected quality outcomes database to examine the outcomes of patients that undergo brain tumor resection and are discharged home the same day as surgery.

METHODS

We have established a prospectively collected quality outcomes database to examine the outcomes of all patients that underwent brain tumor resection by a single neurosurgeon (R.J.K) at our institution from August 2020 to August 2021 and were discharged home the same day as surgery.

RESULTS

Over the one-year period this study was conducted, 37 of 334 patients met inclusion criteria for the outpatient protocol. Thirty-two patients were discharged on the same day as surgery. Five patients (14%) were considered eligible for outpatient surgery but were ultimately admitted to the hospital postoperatively and were discharged after an overnight observation. No postoperative complications were noted at two-week postoperative follow-up.

CONCLUSION

In select patients undergoing brain tumor surgery, same day discharge should be considered. Establishing a multidisciplinary team of physicians, nurses, radiologists, and physical therapists is critical to achieving this aim. Physicians should have a low threshold to admit a patient with concerning exam findings, complications, or complicated past medical history. Once discharged, open communication with the patient and their family is critical to detect complications that should trigger rehospitalization and intervention.

摘要

目的

门诊脑部手术对患者的身心健康都有诸多益处,同时也降低了医疗系统的成本。与住院治疗相比,当天出院可以降低患者感染医院获得性感染、血栓栓塞并发症和医疗错误的风险。我们旨在建立一个前瞻性收集的质量结果数据库,以检查接受脑部肿瘤切除手术并在同一天出院回家的患者的结果。

方法

我们建立了一个前瞻性收集质量结果数据库,以检查 2020 年 8 月至 2021 年 8 月期间由我们机构的一位神经外科医生(R.J.K)进行脑部肿瘤切除手术并在同一天出院回家的所有患者的结果。

结果

在进行这项研究的一年期间,有 37 名患者符合门诊协议的纳入标准。32 名患者在同一天出院。有 5 名患者(14%)符合门诊手术的条件,但最终在术后被收入院,并在观察过夜后出院。在术后两周的随访中,没有发现术后并发症。

结论

在选择进行脑部肿瘤手术的患者中,应考虑当天出院。建立一个由医生、护士、放射科医生和物理治疗师组成的多学科团队对于实现这一目标至关重要。医生应该有一个较低的门槛来收治有令人担忧的检查结果、并发症或复杂病史的患者。一旦出院,与患者及其家属保持开放的沟通对于发现应触发再次住院和干预的并发症至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8513/8861287/a0437467b602/11060_2022_3969_Fig1_HTML.jpg

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