超越手术后加速康复（ERAS）：从多日住院到当日出院的微创结肠切除术的演变。
Beyond enhanced recovery after surgery (ERAS): Evolving minimally invasive colectomy from multi-day admissions to same-day discharge.
机构信息
Madigan Army Medical Center, Tacoma, WA, USA.
MultiCare Health Network, Tacoma, WA, USA.
出版信息
Am J Surg. 2023 May;225(5):826-831. doi: 10.1016/j.amjsurg.2023.01.024. Epub 2023 Jan 21.
INTRODUCTION
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.
METHODS
We studied a retrospective cohort of robotic colorectal surgeries from 2016 to 2022. Colectomies were analyzed as a sub-group and stratified by year.
RESULTS
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.
CONCLUSIONS
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.
简介
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。
方法
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。
结果
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。
结论
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。
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