Madigan Army Medical Center, Tacoma, WA, USA.
MultiCare Health Network, Tacoma, WA, USA.
Am J Surg. 2023 May;225(5):826-831. doi: 10.1016/j.amjsurg.2023.01.024. Epub 2023 Jan 21.
Early discharge is increasingly important in the resource-limited COVID era. Some groups have reported early experiences with same day discharge (SDD) after colectomy. We implemented a routine SDD protocol and report the evolution in our program's outcomes.
We studied a retrospective cohort of robotic colorectal surgeries from 2016 to 2022. Colectomies were analyzed as a sub-group and stratified by year.
The cohort comprised 535 cases, of which 483 were colectomies. Annual case volume increased from 58 to 180 cases (p < 0.001). Operative console time concordantly decreased by 33% (p < 0.001). Average length of stay decreased from five to one days. By 2022, 58% of colectomies were selectively discharged on the same day of surgery. Complication and readmission rates remained constant.
SDD is feasible and safe in selected patients. We illustrate the practical evolution of a surgical practice toward routine SDD, and discuss the factors we found critical to this transition.
在资源有限的新冠时代，提前出院变得越来越重要。一些团队报告了在结肠切除术后当天出院（SDD）的早期经验。我们实施了常规 SDD 方案，并报告了我们方案结果的演变。
我们研究了 2016 年至 2022 年期间的机器人结肠直肠手术的回顾性队列。将结肠切除术作为一个亚组进行分析，并按年份进行分层。
该队列包括 535 例病例，其中 483 例为结肠切除术。每年的病例量从 58 例增加到 180 例（p<0.001）。手术控制台时间相应减少了 33%（p<0.001）。平均住院时间从 5 天减少到 1 天。到 2022 年，58%的结肠切除术可选择性在手术当天出院。并发症和再入院率保持不变。
在选定的患者中，SDD 是可行且安全的。我们展示了手术实践向常规 SDD 的实际演变，并讨论了我们认为对这一转变至关重要的因素。
