择期腹腔镜胆囊切除术患者的术前住院非必要:一项队列研究。
Preoperative admission is non-essential in most patients receiving elective laparoscopic cholecystectomy: A cohort study.
机构信息
Department of Surgery, Sawanpracharak Hospital, Nakhon Sawan, Thailand.
Nong pling, Muang, Nakhon Sawan, Thailand.
出版信息
PLoS One. 2023 Oct 26;18(10):e0293446. doi: 10.1371/journal.pone.0293446. eCollection 2023.
We evaluated conventional overnight-stay laparoscopic cholecystectomy, focusing on the preoperative admission day, to assess the feasibility of implementing daycare laparoscopic cholecystectomy, which is currently underutilized in developing and some Asian countries. We retrospectively reviewed elective laparoscopic cholecystectomy data from March 2020 to February 2022 at a 700-bed tertiary hospital in Thailand. Variables included age, sex, body mass index, comorbidities, American Society of Anesthesiologists status, presence of preoperative anesthesiology visit, laparoscopic cholecystectomy indications, additional intraoperative cholangiography, and surgery cancellations. The primary focus was on preoperative treatment and monitoring needs; secondary outcomes included morbidity, mortality within 30 days, and prolonged hospital stay (>48 hours). Statistical analysis was conducted using the Fisher exact test, t-test, and logistic regression. The study included 405 patients. Of these, 65 (16.1%) received preoperative treatment, with 21 unnecessary (over) treatments and six under-treatments. Based on the results, approximately 12.1% (n = 49) of patients may have theoretically required preoperative admission and treatment. Multivariable analysis showed that the increasing of comorbidities was significantly associated with preoperative management (odds ratio [95% Confidence interval]: 7.0 [2.1, 23.1], 23.9 [6.6, 86.6], 105.5 [17.5, 636.6]) for one, two, and three comorbidities, respectively), but factors such as age, obesity, and American Society of Anesthesiologists status were not. The cohort had 4.2% morbidity (2.2% medical complications), with no mortality. Surgery cancellations occurred in 0.5%. In conclusion, on the basis of our data, a small proportion (12.1%) of patients undergoing elective laparoscopic cholecystectomy may require preoperative admissions to receive the necessary treatment, and most (87.9%) preoperative admissions may not provide treatment benefit. The traditional admission approach was safe but required re-evaluation for optimal resource management.
我们评估了常规 overnight-stay 腹腔镜胆囊切除术,重点关注术前入院日,以评估目前在发展中国家和一些亚洲国家未得到充分利用的日间腹腔镜胆囊切除术的可行性。我们回顾性分析了 2020 年 3 月至 2022 年 2 月在泰国一家 700 床位的三级医院进行的择期腹腔镜胆囊切除术数据。变量包括年龄、性别、体重指数、合并症、美国麻醉医师协会状态、术前麻醉就诊情况、腹腔镜胆囊切除术适应证、术中附加胆管造影术和手术取消。主要重点是术前治疗和监测需求;次要结果包括 30 天内发病率、死亡率和住院时间延长(>48 小时)。使用 Fisher 确切检验、t 检验和逻辑回归进行统计分析。该研究纳入了 405 名患者。其中,65 名(16.1%)接受了术前治疗,其中 21 名(过度)治疗不必要,6 名治疗不足。根据结果,大约 12.1%(n=49)的患者理论上可能需要术前入院和治疗。多变量分析显示,合并症的增加与术前管理显著相关(比值比[95%置信区间]:7.0[2.1, 23.1]、23.9[6.6, 86.6]、105.5[17.5, 636.6]),分别为 1、2 和 3 种合并症),但年龄、肥胖和美国麻醉医师协会状态等因素则不然。该队列的发病率为 4.2%(2.2%为医疗并发症),无死亡病例。手术取消率为 0.5%。总之,根据我们的数据,一小部分(12.1%)择期腹腔镜胆囊切除术患者可能需要术前入院接受必要的治疗,而大多数(87.9%)术前入院可能无法提供治疗益处。传统的入院方式是安全的,但需要重新评估以实现最佳资源管理。