日间手术在原发性和复发性腹腔镜食管裂孔疝修补术中的可行性和结果。
Feasibility and Outcomes of Same-Day Surgery in Primary and Reoperative Laparoscopic Hiatal Hernia Repair.
机构信息
University of Texas Health Science Center at Houston (UT Health), 6400 Fannin Street, Houston, TX, 77030, USA.
Memorial Hermann Southeast Esophageal Disease Center, 11914 Astoria Blvd. # 260, Houston, TX, 77089, USA.
出版信息
J Gastrointest Surg. 2023 Nov;27(11):2287-2296. doi: 10.1007/s11605-023-05807-5. Epub 2023 Sep 5.
OBJECTIVE
To assess the feasibility and outcomes of same-day surgery in primary and reoperative laparoscopic hiatal hernia repairs.
METHODS
Same-day surgery was planned in elective procedures with ASA II-IV. An Enhanced Recovery After Surgery (ERAS) protocol was implemented to achieve same-day surgery, and opioid-based anesthesia was replaced by opioid-free anesthesia. Outcomes were assessed by length of stay, transition from same-day surgery to observation or inpatient, and postoperative emergency department visits/readmissions. The predictors of same-day surgery were assessed. Values are presented as median (interquartile range).
RESULTS
From 04/13/2017 to 09/29/2022, there were 518 laparoscopic hiatal hernia repairs in 491 patients, 428/518 (82.6%) were primary, and 90/518 (17.4%) were reoperative. In the primary group, 314/428 (73.4%) were planned as same-day surgery and 246/314 (78.3%) were performed as same-day surgery. Same-day surgery with opioid-based anesthesia protocol was performed in 77/314 (24.5%) vs. same-day surgery with opioid-free anesthesia protocol in 169/314 (53.8%), p < 0.001, 41/246 (16.7%) same-day surgery primary procedures had emergency department visit post-discharge, and 26/246 (10.6%) were readmitted. In the reoperative group, 51/90 (56.7%) were planned as same-day surgery, and 27/51 (52.9%) were performed as same-day surgery. Same-day surgery with opioid-based anesthesia protocol was performed in 2/51 (3.9%) vs. same-day surgery with opioid-free anesthesia protocol in 25/51 (49.0%), p < 0.001, 3/27 (11.1%) same-day surgery reoperative procedures had emergency department visit post-discharge, and 3/27 (11.1%) were readmitted. Opioid-free anesthesia protocol was the positive predictor of same-day surgery compared to opioid-based anesthesia protocol (OR 7.44 [95% CI: 2.94, 18.83]), p < 0.001. Negative predictors were ASA III compared to II (OR 0.52 [95% CI: 0.28, 0.94]), p = 0.031, and duration of operation (OR 0.98 [0.97, 0.99]) p < 0.001.
CONCLUSION
Laparoscopic hiatal hernia repair can be performed as same-day surgery in the majority of primary and reoperative procedures with good outcomes and low postoperative emergency department visits and readmissions. The odds of same-day surgery are higher with opioid-free anesthesia, lower ASA, and shorter operative time.
目的
评估原发性和复发性腹腔镜食管裂孔疝修补术当天手术的可行性和结果。
方法
计划对 ASA II-IV 的择期手术进行当天手术。实施加速康复外科（ERAS）方案以实现当天手术，并将阿片类药物麻醉改为无阿片类药物麻醉。通过住院时间、从当天手术转为观察或住院以及术后急诊就诊/再入院来评估手术结果。评估了当天手术的预测因素。数值以中位数（四分位距）表示。
结果
2017 年 4 月 13 日至 2022 年 9 月 29 日，491 例患者中有 518 例接受了腹腔镜食管裂孔疝修补术，其中 428 例为原发性，90 例为复发性。在原发性组中，314 例（73.4%）计划为当天手术，246 例（78.3%）实际为当天手术。当天手术中使用阿片类药物方案的有 77 例（24.5%），当天手术中使用无阿片类药物方案的有 169 例（53.8%），p < 0.001，246 例（16.7%）原发性当天手术患者出院后出现急诊就诊，26 例（10.6%）再次入院。在复发性组中，51 例（56.7%）计划为当天手术，27 例（52.9%）实际为当天手术。当天手术中使用阿片类药物方案的有 2 例（3.9%），当天手术中使用无阿片类药物方案的有 25 例（49.0%），p < 0.001，27 例（11.1%）复发性当天手术患者出院后出现急诊就诊，3 例（11.1%）再次入院。与阿片类药物麻醉方案相比，无阿片类药物麻醉方案是当天手术的阳性预测因素（OR 7.44 [95%CI：2.94，18.83]），p < 0.001。负预测因素是与 ASA II 相比 ASA III（OR 0.52 [95%CI：0.28，0.94]），p = 0.031，和手术时间（OR 0.98 [0.97，0.99]），p < 0.001。
结论
腹腔镜食管裂孔疝修补术可在大多数原发性和复发性手术中进行当天手术，具有良好的结果，且术后急诊就诊和再入院率较低。无阿片类药物麻醉、较低的 ASA 分级和较短的手术时间可提高当天手术的可能性。
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