取样腹腔切开术取样不影响当日出院计划

Extraction Laparotomy for Specimen Retrieval Does Not Alter Same-Day Discharge Plans

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Journal of Minimally Invasive Gynecology

影响因子:3.3

分区:医学2区 / 妇产科学2区

发表日期:2025 Feb

作者: Marla E Scott, Dani Ashak, Wilkin F Muñoz Orozco, Allison E Axtell, Scott E Lentz

DOI: 10.1016/j.jmig.2024.09.015

摘要

旨在评估取样腹腔切开术（EL）用于完整标本取出的安全性和可行性，特别是在接受微创手术（MIS）治疗确诊或疑似妇科恶性肿瘤的患者中。回顾性研究，单中心资料。包括在单一机构接受妇科恶性肿瘤微创手术的患者，其中接受EL的为67例，及年龄匹配的对照组134例。比较EL组与非EL组的当日出院（SDD）率、并发症、再入院和门诊随访。共识别1224名患者，67例接受EL取样。对照组为134例年龄匹配患者。EL组的当日出院率为83%，对照组为87%（p=0.39）。两组在中位疼痛评分（1.8 vs 1.9，p=0.86）、住院时间（均为0天，p=0.41）、30天再入院率（6% vs 3%，p=0.45）、急诊就诊（13% vs 10%，p=0.76）以及其他患者联系次数（34% vs 39%，p=0.53）方面无显著差异。EL组标本重量较大（524 g vs 142 g，p<0.001），估算出血量也较多（104 mL vs 46 mL，p<0.001），手术时间延长22分钟（121 vs 99分钟，p<0.001）。EL患者术后需要更多镇痛药（20.5 vs 12.2口服吗啡当量，p=0.033），但这未导致出院时处方镇痛药量增加。多因素逻辑回归分析显示，标本重量较大趋势上增加住院可能性（比值比1.04，95%置信区间：1.01-1.08）；手术时间、术后恢复时间、种族、身体质量指数、手术类型或EL需求均未预测当日出院或住院需求。接受EL的MIS患者仍可实现当日出院，且安全、可行，未增加再入院、疼痛评分或术后非计划联系的风险。

Abstract

To evaluate whether extraction laparotomy (EL) for intact specimen removal adversely affected the feasibility or safety of same-day discharge (SDD) in patients undergoing minimally invasive surgery (MIS) for confirmed or suspected gynecologic malignancies.Retrospective study.Single-institution study.Patients undergoing MIS for gynecologic malignancy at a single institution, who underwent EL (N = 67) and age-matched controls (N = 134).Comparing SDD rates, complications, readmission, and outpatient follow-up after between patients requiring EL and those who did not after minimally invasive gynecologic surgery.A total of 1224 patients were identified. Sixty-seven patients underwent EL for specimen extraction. From the remainder, 134 patients were selected as age-matched controls. SDD rate was 83% (EL) vs 87% (no EL) (p = .39). There was no difference in median pain scores (1.8 vs 1.9 p = .86), length of stay (0 days for both) (p = .41), 30-day readmission rate (6% vs 3%) (p = .45), emergency department visit (13% vs 10%) (p = .76), or any patient contact (34% vs 39%) (p = .53), between the groups. Specimen weight was higher for EL (524 g vs 142 g, p <.001), as was estimated blood loss (104 mL vs 46 mL, p <.001), and surgery time was increased by 22 minutes in the EL group (121 min vs 99 min, p <.001). Patients who underwent EL did require more narcotics in postanesthesia care unit (20.5 vs 12.2 oral morphine equivalent, p = .033); however, this did not translate to increased number of narcotics prescribed at discharge. On logistic regression, a higher specimen weight trended to increase the likelihood of admission (odds ratio, 1.04; confidence interval, 1.01-1.08); however, surgery time, time in postanesthesia care unit, race, body mass index, surgery type, or need for EL did not predict SDD or need for admission.MIS patients who require EL can still achieve SDD. SDD is safe and feasible without increased risk of readmission, pain score, or unscheduled patient contact postoperatively.