Aillaud-De-Uriarte Daniel, Hernandez-Flores Luis A, Hernandez-Moreno Andrea, Zachariah Philip N, Bhatia Ria, Rodriguez-Gaytan Jorge, Marines-Copado Diego
Division of Colon and Rectal Surgery, Houston Methodist Willowbrook Hospital, Houston, USA.
Center for Bioethics, Harvard Medical School, Boston, USA.
Cureus. 2024 Aug 19;16(8):e67250. doi: 10.7759/cureus.67250. eCollection 2024 Aug.
Enhanced Recovery After Surgery (ERAS) protocols have been shown to decrease inpatient length of stay (LOS) and improve surgical outcomes in elective abdominal colorectal procedures. Discharging a patient home after a minimally invasive colectomy on the same calendar day is a multifactorial decision that takes into account the patient's decision and baseline condition, social factors, intraoperative findings, and postoperative recovery status. The aim of this study is to evaluate the outcomes of same-day discharge (SDD) following minimally invasive colectomy within an ERAS protocol in a community hospital setting in Houston, Texas.
In this retrospective cohort study, all consecutive elective cases were performed by a single surgeon from April 2022 to April 2023. This retrospective analysis aims to report a single senior surgeon's experience of the safety, feasibility, and benefits of same-day discharge after minimally invasive colectomy in preselected patients. Same-day discharge was defined as a discharge on the same calendar day without an overnight stay. Differences between specific groups were compared using the Fisher's exact test and Mann-Whitney U test.
Of 86 non-emergent colectomies, 41 patients (47.7%) were successfully discharged on the same day. The median age of the patients was 63.50 years (interquartile range (IQR) 18). The cohort included 37 females (43%) and 49 males (57%). The median LOS was one day. The median operating time was 148.50 minutes (IQR 68.25). The median intraoperative fluid usage was 1500 mL (IQR 36.25), and the median estimated blood loss (EBL) was 25 mL (IQR 36.25). No readmissions among the SDD patients (0%), while three readmissions were reported in patients who stayed overnight (3.4%). Conclusion: Same-day discharge after a minimally invasive colectomy is feasible when there is a well-established ERAS protocol and there is adequate education for patients and staff. Adequate patient selection is crucial. Patients with multiple comorbidities and a lack of a support network are not suitable candidates.
手术加速康复（ERAS）方案已被证明可缩短择期腹部结直肠手术患者的住院时间（LOS）并改善手术结局。在同一天对接受微创结肠切除术的患者进行出院安排是一个多因素决策，需要考虑患者的决定和基线状况、社会因素、术中发现以及术后恢复状况。本研究的目的是评估在德克萨斯州休斯顿的一家社区医院环境中，在ERAS方案下微创结肠切除术后当日出院（SDD）的结局。
在这项回顾性队列研究中，2022年4月至2023年4月期间所有连续的择期病例均由一名外科医生进行。这项回顾性分析旨在报告一位资深外科医生在预先选择的患者中进行微创结肠切除术后当日出院的安全性、可行性和益处的经验。当日出院定义为在同一日历日出院且无需过夜住院。使用Fisher精确检验和Mann-Whitney U检验比较特定组之间的差异。
在86例非急诊结肠切除术中（原文有误，应为86例，根据上下文推测，前面说的86例非急诊手术，这里应该也是86例，而不是84例），41例患者（47.7%）在同一天成功出院。患者的中位年龄为63.50岁（四分位间距（IQR）为18）。该队列包括37名女性（43%）和49名男性（57%）。中位住院时间为1天。中位手术时间为148.50分钟（IQR为68.25）。术中液体使用量中位数为1500 mL（IQR为36.25），估计失血量（EBL）中位数为25 mL（IQR为36.25）。当日出院患者中无再入院情况（0%），而过夜住院患者中有3例再入院（3.4%）。结论：当有完善的ERAS方案且对患者和工作人员进行了充分教育时，微创结肠切除术后当日出院是可行的。充分的患者选择至关重要。患有多种合并症且缺乏支持网络（原文有误，应为支持网络，根据语境推测，这里说的是缺乏家人等支持网络的患者不适合当日出院）的患者不是合适的候选人。
