Teh Swee H, Schecter Samuel C, Servais Edgar B, Liu Kingsway, Svahn Jonathan, Yang Lisa, Goodstein Monica, Parent Richard, Chau Edward, Chang Lynn, Zhou Minhoa, Shiraga Sharon, Knox Michelle
The Permanente Benign Foregut Surgery Group, Northern California Kaiser Permanente, Oakland.
TPMG Consulting Services, The Permanente Medical Group, Oakland, California.
JAMA Surg. 2022 Sep 14;157(11):1000-6. doi: 10.1001/jamasurg.2022.4245.
Same-day home recovery (SHR) is now the standard of care for many major surgical procedures and has the potential to become standard practice for benign foregut procedures (eg, hiatal hernia repair, fundoplication, and Heller myotomy).
To determine whether SHR for patients undergoing benign foregut surgery is feasible, safe, and effective.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study took place across 19 medical centers within an integrated health care system in northern California from January 2019 through September 2021. Participants included consecutive patients undergoing elective benign foregut surgery.
Standardized SHR program.
The primary end point was the rate of SHR. The secondary end points were 7-day and 30-day rates of postoperative emergency department visits, hospital readmissions, and reoperations.
Of 1248 patients who underwent benign foregut surgery from January 2017 through September 2021, 558 were patients before implementation of the SHR program and 690 were patients postimplementation. The mean age of patients was 60 years, and 759 (59%) were female. The preimplementation SHR rate was 64 of 558 patients (11.5%) in 2018 and increased to 82 of 113 patients (72.6%) by 2021 (94/350 [26.9%] in 2019 and 112/227 [49.3%] in 2020; P < .001). There were no statistical differences in the 7-day and 30-day rates of postoperative emergency visits, hospital readmissions, and reoperations or 30-day mortality in the SHR vs non-SHR groups in the postimplementation era.
In this study, implementation of a regional SHR program among patients undergoing elective benign foregut surgery was feasible, safe, and effective. The changes in perioperative care require comprehensive patient education and full multidisciplinary support. An SHR program for benign foregut procedures has the potential to improve patient care and cost-effectiveness in care delivery.
当日家庭康复（SHR）目前是许多重大外科手术的护理标准，并且有可能成为良性前肠手术（如食管裂孔疝修补术、胃底折叠术和贲门肌切开术）的标准做法。
确定接受良性前肠手术的患者进行当日家庭康复是否可行、安全且有效。
设计、地点和参与者：这项前瞻性队列研究于2019年1月至2021年9月在加利福尼亚州北部一个综合医疗保健系统内的19个医疗中心进行。参与者包括连续接受择期良性前肠手术的患者。
标准化的当日家庭康复计划。
主要终点是当日家庭康复率。次要终点是术后7天和30天的急诊就诊率、住院再入院率和再次手术率。
在2017年1月至2021年9月接受良性前肠手术的1248例患者中，558例是在实施当日家庭康复计划之前的患者，690例是实施之后的患者。患者的平均年龄为60岁，759例（59%）为女性。2018年，实施当日家庭康复计划之前的当日家庭康复率为558例患者中的64例（11.5%），到2021年增至113例患者中的82例（72.6%）（2019年为94/350 [26.9%]，2020年为112/227 [49.3%]；P < .001）。在实施当日家庭康复计划之后的时代，当日家庭康复组与非当日家庭康复组在术后7天和30天的急诊就诊率、住院再入院率、再次手术率或30天死亡率方面没有统计学差异。
在本研究中，在接受择期良性前肠手术的患者中实施区域当日家庭康复计划是可行、安全且有效的。围手术期护理的改变需要全面的患者教育和充分的多学科支持。良性前肠手术的当日家庭康复计划有可能改善患者护理以及护理提供中的成本效益。
