Sinai Hospital of Baltimore, Lifebridge Health, 2435 Belvedere Ave, Baltimore, MD, 2121, USA.
Yale University School of Medicine, New Haven, CT, USA.
J Robot Surg. 2024 Oct 14;18(1):366. doi: 10.1007/s11701-024-02121-3.
Background Early discharge (ED) after colectomy has become a target outcome for multiple reasons, but the factors associated with ED are not well characterized. This study investigated the factors associated with ED and evaluated the impact of ED on overall outcome. Methods Data from ACS-NSQIP were used to identify patients who underwent non-emergent colectomy from 2012 to 2021. ED was defined as length of stay ≤ 2 days. Unpaired t-tests, chi-square tests and adjusted multivariate logistic regression modeling were used to estimate associated factors for ED. Bounceback readmission was defined as readmission within 7 days of discharge. Results In this cohort of 282,490 patients, 43,137 (15.3%) met the criteria for ED. Robotic colectomy (OR 14.35; 95% CI [13.63-15.12]) was more strongly associated with ED than any other patient characteristic, including laparoscopic colectomy (6.82 [6.51-7.14], ref open colectomy). ED vs. non-ED patients had lower rates of 30-day (5.84 vs. 10.37%, p < 0.01) and bounceback (3.56 vs. 5.75%, p < 0.01) readmissions, overall complications (5.65 vs. 18.63%, p < 0.01) and post-discharge complications (4.21 vs. 7.49%, p < 0.01). Conclusions Robotic surgery was the variable most strongly associated with ED, with greater odds of ED compared to both laparoscopic and open colectomy. Patients who had ED after robotic surgery had lower rates of complications and readmission compared to non-ED patients.
出于多种原因，结肠切除术的早期出院（ED）已成为一个目标结果，但与 ED 相关的因素尚未得到很好的描述。本研究调查了与 ED 相关的因素，并评估了 ED 对总体结果的影响。
使用 ACS-NSQIP 数据确定 2012 年至 2021 年期间接受非紧急结肠切除术的患者。ED 定义为住院时间≤2 天。使用未配对 t 检验、卡方检验和调整后的多变量逻辑回归模型来估计 ED 的相关因素。反弹再入院定义为出院后 7 天内再次入院。
在本队列的 282490 名患者中，43137 名（15.3%）符合 ED 标准。与任何其他患者特征相比，机器人结肠切除术（OR 14.35；95%CI [13.63-15.12]）与 ED 的相关性更强，包括腹腔镜结肠切除术（6.82 [6.51-7.14]，参考开放结肠切除术）。ED 与非 ED 患者的 30 天（5.84%比 10.37%，p<0.01）和反弹（3.56%比 5.75%，p<0.01）再入院率、总并发症（5.65%比 18.63%，p<0.01）和出院后并发症（4.21%比 7.49%，p<0.01）较低。
机器人手术是与 ED 最密切相关的变量，与腹腔镜和开放结肠切除术相比，ED 的可能性更大。与非 ED 患者相比，接受机器人手术后 ED 的患者的并发症和再入院率较低。
