患者微创子宫切除术后报告的症状及其与术后并发症的关系。
Patient-reported symptoms after minimally invasive hysterectomy and association with postoperative complications.
机构信息
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA.
出版信息
Gynecol Oncol. 2023 Aug;175:163-168. doi: 10.1016/j.ygyno.2023.06.011. Epub 2023 Jun 28.
OBJECTIVE
To describe patient-reported postoperative symptoms and to evaluate the use of digital symptom tracking and alerts to detect postoperative complications.
METHODS
We retrospectively reviewed patients who underwent a minimally invasive hysterectomy and enrolled in our Recovery Tracker program from 4/5/17-12/31/21. The Recovery Tracker is an at-home virtual tool used to track patient-reported postoperative symptoms for 10 days. Predefined thresholds for "red" and "yellow" alerts are based on symptom severity and timing. Data on patient demographics, surgery, and postoperative course were collected to evaluate the association of alerts with complications and compare outcomes of patients who did/did not enroll in the program.
RESULTS
Of 2362 eligible patients, 1694 (71.7%) enrolled in the Recovery Tracker program. Pain was the most severe symptom, followed by fatigue. Eighty-seven patients experienced 102 complications (5.1% complication rate) and 32 experienced 39 grade ≥ 2 complications (1.9% severe complication rate). Excluding complications that occurred prior to Recovery Tracker use, 1673 patients experienced 28 grade ≥ 2 complications. Of 345 patients (20.6%) who triggered a red alert, 13 (3.8%) had a grade ≥ 2 complication. Of 1328 patients (79.4%) with no red alerts, 15 (1.13%) had a grade ≥ 2 complication. Relative risk of a grade ≥ 2 complication if a red alert was triggered was 3.25 (95% CI: 1.6-6.9, P = .002). Rate of severe complications was significantly higher among patients who did not use the tool (3.3% vs 1.9%; P = .04).
CONCLUSIONS
The Recovery Tracker tool may assist in early identification of postoperative symptoms after minimally invasive hysterectomy.
目的
描述患者报告的术后症状，并评估使用数字症状跟踪和警报来检测术后并发症。
方法
我们回顾性分析了 2017 年 4 月 5 日至 2021 年 12 月 31 日期间接受微创子宫切除术并参加我们的 Recovery Tracker 计划的患者。Recovery Tracker 是一种家庭虚拟工具，用于跟踪患者报告的术后症状 10 天。“红色”和“黄色”警报的预设阈值基于症状严重程度和时间。收集患者人口统计学、手术和术后病程的数据，以评估警报与并发症的关联，并比较参加和未参加该计划的患者的结局。
结果
在 2362 名合格患者中，1694 名（71.7%）参加了 Recovery Tracker 计划。疼痛是最严重的症状，其次是疲劳。87 名患者发生 102 种并发症（5.1%的并发症发生率），32 名患者发生 39 种≥2 级并发症（1.9%的严重并发症发生率）。排除 Recovery Tracker 使用前发生的并发症，1673 名患者发生 28 种≥2 级并发症。在 345 名（20.6%）触发红色警报的患者中，13 名（3.8%）发生≥2 级并发症。在 1328 名（79.4%）没有红色警报的患者中，15 名（1.13%）发生≥2 级并发症。如果触发红色警报，发生≥2 级并发症的相对风险为 3.25（95%CI：1.6-6.9，P=0.002）。未使用该工具的患者严重并发症发生率显著较高（3.3%比 1.9%；P=0.04）。
结论
Recovery Tracker 工具可能有助于早期识别微创子宫切除术后的术后症状。
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