Reuter Susanne, Schmalfeldt Barbara, Haas Sebastian A, Zapf Antonia, Cevirme Sinan, Prieske Katharina, Wölber Linn, Müller Volkmar, Zöllner Christian, Jaeger Anna
Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsmedizin Rostock, Rostock, Germany.
Geburtshilfe Frauenheilkd. 2023 Jun 2;83(8):1022-1030. doi: 10.1055/a-2055-9349. eCollection 2023 Aug.
Patients with ovarian cancer who undergo multivisceral surgery usually require intensive care monitoring postoperatively. In view of the ever-fewer numbers of high-care/intensive care beds and the introduction of fast-track treatment concepts, it is increasingly being suggested that these patients should be cared for postoperatively in 24-h Post Anesthesia Care Units (PACU24). No analyses have been carried out to date to investigate whether such a postoperative care concept might be associated with a potential increase in postoperative complications in this patient cohort.
A PACU24 unit was set up in our institution in 2015 and it has become the primary postoperative care pathway for patients with ovarian cancer who have undergone cytoreductive (debulking) surgery. A structured, retrospective analysis of data from patients treated before (control group) and (PACU group) the introduction of this care concept was carried out, with a particular focus on postoperative complications and secondary admission to an intensive care unit where necessary.
The data of 42 patients were analyzed for the PACU group and 45 patients for the control group. According to the analysis, the preoperative and surgical data of both groups were comparable (age, ASA, BMI, FIGO stage, duration of surgery, blood loss). The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM score) as a measure for the risk of postoperative complications was higher in the PACU group (11.1% vs. 9.7%, p = 0.001). Patients in the PACU group underwent bowel resection with anastomosis significantly more often (76.3% vs. 33.3%, p < 0.001), although the extent of surgery was otherwise comparable. The total number, type and severity of postoperative complications and the duration of the overall stay in hospital did not differ between the two groups. None of the patients required secondary transfer from the PACU or normal ward to an intensive care unit (ICU).
Our data support the assumption that the care concept of transferring patients to a PACU24 represents a safe and cost-saving care pathway for the postoperative care of patients even after complex gynecological-oncological procedures.
接受多脏器手术的卵巢癌患者术后通常需要重症监护。鉴于高护理/重症监护床位数量日益减少以及快速康复治疗理念的引入，越来越多的人建议这些患者术后应在24小时麻醉后监护病房（PACU24）接受护理。迄今为止，尚未进行分析以调查这种术后护理理念是否可能与该患者群体术后并发症的潜在增加相关。
2015年我们机构设立了PACU24病房，它已成为接受减瘤手术的卵巢癌患者术后的主要护理途径。对引入该护理理念之前（对照组）和之后（PACU组）治疗的患者数据进行了结构化回顾性分析，特别关注术后并发症以及必要时再次入住重症监护病房的情况。
分析了PACU组42例患者和对照组45例患者的数据。根据分析，两组的术前和手术数据具有可比性（年龄、美国麻醉医师协会身体状况分级、体重指数、国际妇产科联盟分期、手术时间、失血量）。作为术后并发症风险衡量指标的死亡率和发病率枚举生理和手术严重程度评分（POSSUM评分）在PACU组中更高（11.1%对9.7%，p = 0.001）。PACU组患者进行肠切除吻合术更为频繁（76.3%对33.3%，p < 0.001），尽管手术范围在其他方面具有可比性。两组术后并发症的总数、类型和严重程度以及总住院时间没有差异。没有患者需要从PACU或普通病房再次转至重症监护病房（ICU）。
我们的数据支持这样一种假设，即对于患者术后护理而言，将患者转至PACU24的护理理念即使在复杂的妇科肿瘤手术之后也是一种安全且节省成本的护理途径。
