Liu Jia, Chen Yali, Tan Xin, Chen Hengxi
Pathology Department, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
Front Oncol. 2024 Jan 9;13:1307694. doi: 10.3389/fonc.2023.1307694. eCollection 2023.
To explore the factors influencing the successful implementation of same-day discharge in patients undergoing minimally invasive hysterectomy for malignant and non-malignant gynecological diseases.
We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, and Clinical Trials.gov from inception to May 23, 2023. We included case-control and cohort studies published in English reporting same-day discharge factors in patients undergoing minimally invasive hysterectomy for malignant and non-malignant gynecological diseases. STATA 16.0 was used for the meta-analysis. Risk factors were assessed using odds ratios (OR) (relative risk (RR)/hazard ratios (HR)) with 95% confidence intervals (CI), and logistic regression determined the same-day discharge rate (%).
We analyzed 29 studies with 218192 patients scheduled for or meeting same-day discharge criteria. The pooled rates were 50% (95% CI 0.46-0.55), and were similar for malignant and non-malignant gynecological diseases (48% and 47%, respectively). In terms of basic characteristics, an increase in age (OR: 1.03; 95% CI: 1.01-1.05), BMI (OR: 1.02; 95% CI: 1.01-1.03), and comorbidities including diabetes and lung disease were risk factors affecting SDD, while previous abdominal surgery history (OR: 1.54; 95% CI: 0.93-2.55) and hypertension (OR: 1.53; 95% CI: 0.80-2.93) appeared not to affect SDD. In terms of surgical characteristics, radical hysterectomy (OR: 3.46; 95% CI: 1.90-6.29), surgery starting after 14:00 (OR: 4.07; 95% CI: 1.36-12.17), longer surgical time (OR: 1.03; 95% CI: 1.01-1.06), intraoperative complications (OR: 4.68; 95% CI: 1.78-12.27), postoperative complications (OR: 3.97; 95% CI: 1.68-9.39), and surgeon preference (OR: 4.47; 95% CI: 2.08-9.60) were identified as risk factors. However, robotic surgery (OR: 0.44; 95% CI: 0.14-1.42) and intraoperative blood loss (OR: 1.16; 95% CI: 0.98-1.38) did not affect same-day discharge.
An increase in age, body mass index, and distance to home; certain comorbidities (e.g., diabetes, lung disease), radical hysterectomy, surgery starting after 14:00, longer surgical time, operative complications, and surgeon preference were risk factors preventing same-day discharge. Same-day discharge rates were similar between malignant and non-malignant gynecological diseases. The surgery start time and body mass index have a greater impact on same-day discharge for malignant diseases than non-malignant diseases.
探讨影响恶性和非恶性妇科疾病微创子宫切除患者当日出院成功实施的因素。
我们检索了从创刊至2023年5月23日的PubMed、Embase、Cochrane对照试验中央注册库、国际临床试验注册平台和ClinicalTrials.gov。我们纳入了以英文发表的病例对照研究和队列研究，这些研究报告了恶性和非恶性妇科疾病微创子宫切除患者的当日出院因素。使用STATA 16.0进行荟萃分析。使用比值比（OR）（相对风险（RR）/风险比（HR））及95%置信区间（CI）评估危险因素，并通过逻辑回归确定当日出院率（%）。
我们分析了29项研究，共218192例计划或符合当日出院标准的患者。汇总率为50%（95%CI 0.46 - 0.55），恶性和非恶性妇科疾病的汇总率相似（分别为48%和47%）。在基本特征方面，年龄增加（OR：1.03；95%CI：1.01 - 1.05）、体重指数（BMI）增加（OR：1.02；95%CI：1.01 - 1.03）以及包括糖尿病和肺部疾病在内的合并症是影响当日出院的危险因素，而既往腹部手术史（OR：1.54；95%CI：0.93 - 2.55）和高血压（OR：1.53；95%CI：0.80 - 2.93）似乎不影响当日出院。在手术特征方面，根治性子宫切除术（OR：3.46；95%CI：1.90 - 6.29）、14:00后开始手术（OR：4.07；CI：1.36 - 12.17）、手术时间较长（OR：1.03；95%CI：1.01 - 1.06）、术中并发症（OR：4.68；95%CI：1.78 - 12.27）、术后并发症（OR：3.97；95%CI：1.68 - 9.39）以及外科医生偏好（OR：4.47；95%CI：2.08 - 9.60）被确定为危险因素。然而，机器人手术（OR：0.44；95%CI：0.14 - 1.42）和术中失血（OR：1.16；95%CI：0.98 - 1.38）不影响当日出院。
年龄、体重指数和离家距离增加；某些合并症（如糖尿病、肺部疾病）、根治性子宫切除术、14:00后开始手术、手术时间较长、手术并发症和外科医生偏好是阻碍当日出院的危险因素。恶性和非恶性妇科疾病的当日出院率相似。手术开始时间和体重指数对恶性疾病当日出院的影响大于非恶性疾病。
