Bonnema J, van Wersch A M, van Geel A N, Pruyn J F, Schmitz P I, Paul M A, Wiggers T
Department of Surgical Oncology, University Hospital Rotterdam/Daniel den Hoed Cancer Center, Zuider Hospital Rotterdam, PO Box 5201, 3008 AE Rotterdam, Netherlands.
BMJ. 1998 Apr 25;316(7140):1267-71. doi: 10.1136/bmj.316.7140.1267.
To assess the medical and psychosocial effects of early hospital discharge after surgery for breast cancer on complication rate, patient satisfaction, and psychosocial outcomes.
Randomised trial comparing discharge from hospital 4 days after surgery (with drain in situ) with discharge after drain removal (mean 9 days in hospital). Psychosocial measurements performed before surgery and 1 and 4 months after.
General hospital and cancer clinic in Rotterdam with a socioeconomically diverse population.
125 women with operable breast cancer.
Incidence of complications after surgery for breast cancer, patient satisfaction with treatment, and psychosocial effects of short stay or long stay in hospital.
Patient satisfaction with the short stay in hospital was high; only 4% (2/56 at 1 month after surgery and 2/52 at 4 months after surgery) of patients indicated that they would have preferred a longer stay. There were no significant differences in duration of drainage from the axilla between the short stay and long stay groups (median 8 v 9 days respectively, P=0.45) or the incidence of wound complications (10 patients v 9 patients). The median number of seroma aspirations per patient was higher for the long stay group (1 v 3.5, P=0.04). Leakage along the drain occurred more frequently in short stay patients (21 v 10 patients, P=0.04). The two groups did not differ in scores for psychosocial problems (uncertainty, anxiety, loneliness, disturbed sleep, loss of control, threat to self esteem), physical or psychological complaints, or in the coping strategies used. Before surgery, short stay patients scored higher on scales of depression (P=0.03) and after surgery they were more likely to discuss their disease with their families (at 1 month P=0.004, at 4 months P=0.04).
Early discharge from hospital after surgery for breast cancer is safe and is well received by patients. Early discharge seems to enhance the opportunity for social support within the family.
评估乳腺癌手术后早期出院对并发症发生率、患者满意度及心理社会结局的医学和心理社会影响。
随机试验，比较术后4天（引流管仍在位）出院与引流管拔除后出院（平均住院9天）的情况。在手术前、术后1个月和4个月进行心理社会测量。
鹿特丹的综合医院和癌症诊所，患者社会经济背景多样。
125例可手术乳腺癌女性患者。
乳腺癌手术后并发症的发生率、患者对治疗的满意度以及短期或长期住院的心理社会影响。
患者对短期住院的满意度较高；仅4%（术后1个月时56例中有2例，术后4个月时52例中有2例）的患者表示希望住院时间更长。短期住院组和长期住院组腋窝引流时间无显著差异（中位数分别为8天和9天，P = 0.45），伤口并发症发生率也无显著差异（分别为10例和9例）。长期住院组每位患者血清肿抽吸的中位数更高（1次对3.5次，P = 0.04）。短期住院患者引流管周围渗漏更频繁（21例对10例，P = 0.04）。两组在心理社会问题（不确定性、焦虑、孤独、睡眠障碍、失去控制感、自尊受到威胁）、身体或心理不适或所采用的应对策略方面得分无差异。手术前，短期住院患者在抑郁量表上得分更高（P = 0.03），术后他们更有可能与家人讨论自己的病情（术后1个月时P = 0.004，术后第4个月时P = 0.04）。
乳腺癌手术后早期出院是安全的，且患者接受度良好。早期出院似乎增加了家庭内部社会支持的机会。
