影响社区医院住院与日间手术乳房切除术患者、手术和疼痛管理因素的比较。
Patient, operative and pain management factors influencing inpatient compared with surgical day care mastectomy procedures at a community hospital.
机构信息
Department of Urology, University of British Columbia, Vancouver, BC (Davey); Division of General Surgery, University of British Columbia, Vancouver, BC (Chen, Hwang); Division of General Surgery, Vernon Jubilee Hospital, Vernon, BC (Hwang).
Department of Urology, University of British Columbia, Vancouver, BC (Davey); Division of General Surgery, University of British Columbia, Vancouver, BC (Chen, Hwang); Division of General Surgery, Vernon Jubilee Hospital, Vernon, BC (Hwang)
出版信息
Can J Surg. 2023 Jul 27;66(4):E403-E408. doi: 10.1503/cjs.010422. Print 2023 Jul-Aug.
BACKGROUND
The COVID-19 pandemic highlighted the importance of maximizing same-day discharge after surgery to mitigate potential patient harms associated with inpatient admission and conserve valuable hospital resources. Adoption of same-day discharge after breast surgery, particularly mastectomy, has been slow despite recent research suggesting the physical and psychological benefits of same-day discharge after surgery. We sought to identify factors associated with inpatient compared with surgical day care mastectomy procedures at a community hospital in Vernon, British Columbia.
METHODS
We conducted a retrospective chart review of all patients who underwent a total mastectomy without reconstruction at Vernon Jubilee Hospital, a 196-bed community hospital, between April 2016 and March 2019. Patient characteristics, operative variables and pain management were compared between inpatient and surgical day care mastectomy procedures. We also compared 7-day readmission, reoperation and complications.
RESULTS
A total of 187 mastectomy patients were analyzed with 72 (38.5%) surgical day care procedures. Factors associated with inpatient procedures included longer operative time (66.1 min v. 53.5 min, = 0.001), bilateral mastectomy (91% v. 9%, = 0.01) and suspected or confirmed obstructive sleep apnea (32% v. 17%, = 0.04). Preoperative acetaminophen (83% v. 17%, < 0.001), multilevel intercostal block (83% v. 17%, < 0.001) and a prescription for acetaminophen plus tramadol (58% v. 42%, < 0.001) were associated with day care surgeries. There were no significant differences between the inpatient and surgical day care groups with respect to 7-day readmission, reoperation or postoperative complications.
CONCLUSION
We found no significant differences in surgical outcomes between inpatients and those with same-day discharge after mastectomy procedures. These findings add to the growing body of evidence that surgical day care mastectomy procedures are safe in the community setting.
背景
新冠疫情凸显了最大化手术后当天出院的重要性，以减轻与住院相关的潜在患者伤害，并节约宝贵的医院资源。尽管最近的研究表明手术后当天出院具有身体和心理上的益处，但在不列颠哥伦比亚省弗农的一家社区医院，采用乳房手术后当天出院（尤其是乳房切除术）的速度仍然缓慢。
方法
我们对 2016 年 4 月至 2019 年 3 月期间在拥有 196 张床位的社区医院弗农 Jubilee 医院接受全乳房切除术（不进行重建）的所有患者进行了回顾性图表审查。对住院和日间护理乳房切除术患者的患者特征、手术变量和疼痛管理进行了比较。我们还比较了 7 天内再入院、再次手术和并发症的情况。
结果
共分析了 187 例乳房切除术患者，其中 72 例（38.5%）为日间护理手术。与住院手术相关的因素包括手术时间较长（66.1 分钟比 53.5 分钟， = 0.001）、双侧乳房切除术（91%比 9%， = 0.01）和疑似或确诊阻塞性睡眠呼吸暂停（32%比 17%， = 0.04）。术前使用对乙酰氨基酚（83%比 17%，< 0.001）、多水平肋间神经阻滞（83%比 17%，< 0.001）和对乙酰氨基酚加曲马多的处方（58%比 42%，< 0.001）与日间护理手术相关。在 7 天内再入院、再次手术或术后并发症方面，住院组和日间护理组之间无显著差异。
结论
我们发现，在乳房切除术患者中，住院患者和当天出院患者的手术结果没有显著差异。这些发现增加了越来越多的证据，即社区环境下的日间护理乳房切除术是安全的。
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