Multicare Health Network, Tacoma, WA, 98405, USA.
University of Portland, Portland, OR, 97203, USA.
J Robot Surg. 2023 Jun;17(3):827-834. doi: 10.1007/s11701-022-01463-0. Epub 2022 Nov 5.
Enhanced recovery after surgery (ERAS) protocols employ multiple factors to decrease surgical stress and improve recovery (Lyon et al., World J Gastroenterol 18(40):5661-5663, 2012). These protocols use multimodal approaches to improve outcomes, including length of stay and morbidities (Lyon et al., World J Gastroenterol 18(40):5661-5663, 2012; Carmichael et al., Dis Colon Rectum 60:761-784, 2017). The ERAS guidelines have evolved since development; however, the question is posed of how to improve next (Lyon et al., World J Gastroenterol 18(40):5661-5663, 2012). With the success of ERAS, in combination with milestones made by minimally invasive surgery (MIS), it is our aim to describe the next step of same day discharge colectomy. Retrospective review was performed on all colectomies from February 2019 to January 2022. Same day discharge (SDD) was defined as admission less than 23 h and no overnight stay. Procedures were nonemergent and MIS. Patients were candidates SDD based on comorbidities, communication means, and social support. SDD candidacy continued if surgery was uncomplicated. Next, patients were required to achieve strict Post Anesthesia Care Unit (PACU) criteria for discharge. SDD patients were monitored via calls or messages until their first appointment. After analysis, 326 total colectomies were identified; based on inclusion and exclusion criteria, 115 patients underwent SDD, 35.3%. Of the 115 SDD, 5 patients returned to the emergency department, only 1 required readmission (0.9%). The most performed procedures were low anterior resection, 61 (53.0%), and right hemicolectomy, 25 (21.7%). Using ERAS protocols as a groundwork to improve upon, we identified several ways to advance select patients into SDD. Using strict patient selection, intraoperative regulations, and rigorous postoperative criteria, we found that SDD as an advancement of ERAS is a relatively safe procedure with minimal complications.
术后恢复加速（ERAS）方案采用多种因素来减轻手术应激，促进康复（Lyon 等人，World J Gastroenterol 18(40):5661-5663, 2012）。这些方案采用多模式方法来改善结局，包括住院时间和发病率（Lyon 等人，World J Gastroenterol 18(40):5661-5663, 2012；Carmichael 等人，Dis Colon Rectum 60:761-784, 2017）。自制定以来，ERAS 指南一直在不断发展；然而，问题是如何进一步改进（Lyon 等人，World J Gastroenterol 18(40):5661-5663, 2012）。随着 ERAS 的成功，结合微创外科（MIS）取得的里程碑，我们旨在描述当天出院结肠切除术的下一步。对 2019 年 2 月至 2022 年 1 月期间所有结肠切除术进行回顾性分析。当天出院（SDD）定义为入院时间少于 23 小时且无过夜。手术为非紧急手术且采用 MIS。基于合并症、沟通方式和社会支持，患者为 SDD 候选者。如果手术无并发症，则继续为 SDD 候选者。接下来，患者需要达到严格的麻醉后护理病房（PACU）出院标准。通过电话或短信对 SDD 患者进行监测，直到他们的第一次预约。分析后，共确定 326 例全结肠切除术；根据纳入和排除标准，115 例患者行 SDD，占 35.3%。在 115 例 SDD 中，5 例患者返回急诊部，仅 1 例需要再次入院（0.9%）。最常进行的手术是低位前切除术，61 例（53.0%）和右半结肠切除术，25 例（21.7%）。在 ERAS 方案的基础上进一步改进，我们确定了几种方法可以将选择的患者推进 SDD。通过严格的患者选择、术中规定和严格的术后标准，我们发现 SDD 作为 ERAS 的一项进展是一种相对安全的手术，并发症很少。
