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经尿道膀胱肿瘤切除术(TURBT)作为日间手术:一家区综合医院(DGH)的实际情况与患者视角

Transurethral resection of bladder tumour (TURBT) as a day-case: A real-world practice and patients' perspective from a district general hospital (DGH).

作者信息

Ippoliti Simona, Bhatt Nikita R, Ilie Cristian P

机构信息

The Queen Elizabeth Hospital, King's Lynn NHS Foundation Trust, King's Lynn, UK.

Harrogate District General Hospital, NHS Foundation Trust, Harrogate, UK.

出版信息

Urologia. 2023 Feb;90(1):68-74. doi: 10.1177/03915603221110177. Epub 2022 Jul 12.

Abstract

INTRODUCTION

Day-case transurethral resection of bladder tumour (TURBT) is currently only performed in 18% cases across the United Kingdom. To determine 30-day readmission rate and morbidity after day-case TURBT in a district general hospital (DGH) and to report patient demographics, quality of TURBT and early recurrence rate as well as patient feedback after day-case TURBT.

METHODS

A retrospective audit of day-case TURBTs over a 3-year pre-COVID19 (2017-20) was performed. We only included patients who underwent a TURBT and excluded any cystoscopy and biopsy or fulguration. A day-case TURBT pathway is in place in this centre. Feedback was obtained using hospital patient feedback forms.

RESULTS

We included 77 patients who underwent TURBT in the day-case theatre, of these 5 patients required in-patient stay after the surgery. Of the remaining 72 discharged on the same day, 8 were re-admitted (11%) for Clavien-Dindo I complications. The readmission/failed discharge group had a higher rate of older patients, with higher ASA scores and longer operative times, however resection quality and tumour characteristics were not different from the day-case TURBTs. All patients reported an overall positive experience (good or very good).

CONCLUSIONS

In the first of its kind audit reporting patient feedback after day-case TURBT, the data obtained can provide us and other centres adopting day-case TURBTs guidance to employ better patient selection to reduce readmission rates. Hence, day-case TURBT can be a feasible option in appropriately selected patients, with a suitable pathway in place.

摘要

引言

日间经尿道膀胱肿瘤切除术(TURBT)目前在英国仅18%的病例中实施。本研究旨在确定一家区综合医院(DGH)日间TURBT术后30天再入院率及发病率,并报告患者人口统计学特征、TURBT质量、早期复发率以及日间TURBT术后患者反馈。

方法

对2017 - 2020年新冠疫情前3年期间的日间TURBT进行回顾性审计。我们仅纳入接受TURBT的患者,排除任何膀胱镜检查、活检或电灼术。本中心已建立日间TURBT流程。通过医院患者反馈表获取反馈。

结果

我们纳入了77例在日间手术室接受TURBT的患者,其中5例术后需要住院。其余72例当日出院的患者中,8例(11%)因Clavien - Dindo I级并发症再次入院。再入院/出院失败组老年患者比例更高,ASA评分更高,手术时间更长,然而切除质量和肿瘤特征与日间TURBT患者并无差异。所有患者总体反馈良好(好或非常好)。

结论

在同类首次报告日间TURBT术后患者反馈的审计中,所获数据可为我们及其他采用日间TURBT的中心提供指导,以便更好地选择患者以降低再入院率。因此,对于适当选择的患者,在有合适流程的情况下,日间TURBT是一种可行的选择。

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