Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Anaesthesia. 2022 May;77(5):555-561. doi: 10.1111/anae.15682. Epub 2022 Mar 8.
Little is known about functional recovery following patient discharge in an established enhanced recovery programme after video-assisted thoracoscopic lobectomy. We conducted a single-centre pilot prospective observational cohort study. We hypothesised that patients achieved early functional recovery after discharge. A total of 32 patients aged ≥ 18 years were enrolled. A digital device was used for objective activity measurements, and patient-reported outcomes were collected as subjective measurements. Primary outcomes were the difference in physical activity; sleep duration; pain; fatigue; and average quality of life scores between pre-operative baseline and 7 days following discharge. The secondary outcome was the reason for reduced daily activity during the first 7 days after discharge. Median (IQR [range]) length of stay was 3 (2-5 [1-13]) days. Up to post-discharge day 7, total, lower intensity and moderate-to-vigorous activities were lower than pre-operative activity (p < 0.001; p = 0.005 and p = 0.027, respectively). Numerical rating scale (0-10) pain scores increased postoperatively at rest (mean difference 1.2, p < 0.001) and during walking (mean difference 1.4, p < 0.001). Fatigue assessed by the Christensen Fatigue Scale (1-10) was also increased postoperatively (mean difference 1.7, p = 0.001). There was a reduction in quality of life scores, while sedentary activity and sleep duration were unchanged postoperatively. Dominant reasons for not recovering daily activity included fatigue in 43% and pain in 33% of patients. Despite compliance with an enhanced recovery programme with a median length of hospital stay of 3 days after video-assisted thoracoscopic lobectomy, functional recovery was not achieved within 7 days after hospital discharge. Reduction in postoperative pain and fatigue are important factors to enhance functional recovery.
关于在既定的电视辅助胸腔镜肺叶切除术后加速康复计划中，患者出院后的功能恢复情况知之甚少。我们进行了一项单中心前瞻性观察队列研究。我们假设患者在出院后能够早期恢复功能。共纳入 32 名年龄≥18 岁的患者。使用数字设备进行客观活动测量，并收集患者报告的结果作为主观测量。主要结果是术后 7 天内与术前基线相比，体力活动、睡眠持续时间、疼痛、疲劳和平均生活质量评分的差异。次要结果是出院后 7 天内日常活动减少的原因。中位（IQR[范围]）住院时间为 3（2-5[1-13]）天。直至出院后第 7 天，总活动量、低强度活动量和中高强度活动量均低于术前活动量（p<0.001;p=0.005 和 p=0.027）。术后静息时（平均差值 1.2，p<0.001）和行走时（平均差值 1.4，p<0.001）的数字评分量表（0-10）疼痛评分增加。通过 Christensen 疲劳量表（1-10）评估的疲劳也增加（平均差值 1.7，p=0.001）。术后生活质量评分降低，而静坐活动和睡眠持续时间不变。未恢复日常活动的主要原因包括 43%的患者疲劳和 33%的患者疼痛。尽管在电视辅助胸腔镜肺叶切除术后接受了加速康复计划，平均住院时间为 3 天，但出院后 7 天内仍未实现功能恢复。减轻术后疼痛和疲劳是促进功能恢复的重要因素。
