Stuart Christina M, Dyas Adam R, Mott Nicole M, Bata Kyle E, Bronsert Michael R, Kelleher Alyson D, McCabe Katherine O, Erickson Crystal, Randhawa Simran K, David Elizabeth A, Mitchell John D, Meguid Robert A
Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA.
J Thorac Dis. 2024 Nov 30;16(11):7300-7309. doi: 10.21037/jtd-24-1183. Epub 2024 Nov 29.
The impact of post-surgical same day ambulation in lung resection patients is relatively unstudied. We sought to determine the relationship between day of surgery ambulation and postoperative outcomes after lung resection.
This was a prospective cohort study at one healthcare system with six hospitals (1/2019-3/2023). Patients undergoing segmentectomy and lobectomy were targeted for inclusion. Patients who had missing ambulation data were excluded. Patients were divided into two cohorts based on whether or not they ambulated postoperatively on the day of surgery. Postoperative outcomes were compared using chi-square, Fisher's exact, or Mann-Whitney- tests. Multivariable logistic regression controlling for pertinent perioperative confounders was performed to identify the independent effect of ambulation on complication rates.
Of 1,056 patients included in the analytic cohort, 443 patients (42.0%) ambulated postoperatively on the day of surgery. Patients who ambulated day of surgery had significantly lower rates of morbidity, including respiratory complications, surgical site infection, bleeding, cardiac complications, cardiac arrhythmias, infectious complications, and opioid use, and had shorter length of stay, shorter chest tube duration, and lower total hospital cost. After risk-adjustment, patients who ambulated day of surgery had lower odds of overall morbidity, less opioid consumption, shorter length of stay, and shorter chest tube duration.
Patients who ambulated postoperatively on the day of surgery had better surgical recovery and outcomes after lung resection than those who did not. Day of surgery ambulation is an excellent quality metric and associated with avoidance of postoperative complications.
肺切除患者术后当日下床活动的影响相对较少被研究。我们试图确定手术当日下床活动与肺切除术后结果之间的关系。
这是一项在一个拥有六家医院的医疗系统中进行的前瞻性队列研究（2019年1月至2023年3月）。纳入对象为接受肺段切除术和肺叶切除术的患者。排除下床活动数据缺失的患者。根据患者术后手术当日是否下床活动分为两个队列。使用卡方检验、Fisher精确检验或Mann-Whitney检验比较术后结果。进行多变量逻辑回归以控制相关围手术期混杂因素，从而确定下床活动对并发症发生率的独立影响。
在纳入分析队列的1056例患者中，443例患者（42.0%）术后手术当日下床活动。手术当日下床活动的患者发病率显著较低，包括呼吸并发症、手术部位感染、出血、心脏并发症、心律失常、感染性并发症和阿片类药物使用，并且住院时间更短、胸管留置时间更短、总住院费用更低。经过风险调整后，手术当日下床活动的患者总体发病几率更低、阿片类药物消耗量更少、住院时间更短、胸管留置时间更短。
肺切除术后手术当日下床活动的患者比未下床活动的患者手术恢复更好，结果更佳。手术当日下床活动是一个优秀的质量指标，且与避免术后并发症相关。
