试样检索的提取剖腹手术不会改变当天的出院计划
Extraction Laparotomy for Specimen Retrieval Does Not Alter Same-Day Discharge Plans
影响因子:3.30000
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
摘要
评估用于清除完整样本的提取剖腹手术（EL）是否会对当天出院（SDD）的可行性或安全性（SDD）的可行性或安全性，对经过微创手术（MIS）的患者确认或怀疑的妇科性恶性肿瘤的确认或怀疑性恶性肿瘤研究。逆转性研究。 （n = 67）和年龄匹配的对照（n = 134）。在需要EL的患者和那些在最小侵入性的妇科手术之后未进行的患者之间，SDD率，并发症，再入院和门诊随访。总共确定了1224名患者。六十七名患者接受了EL用于提取标本。从其余部分开始，将134例患者选择为年龄匹配的对照。 SDD率为83％（EL）vs 87％（无EL）（p = .39）。中间疼痛评分（1.8 vs 1.9 p = .86），住院时间长度（两者为0天）（p = .41），30天的再入院率（6％vs 3％）（P = .45）（P = .45），急诊室访问（13％vs 10％）（P = .76）（P = .76）或任何患者的联系（34％VS 39％）（p = .53）（P = .53），没有差异。 EL（524 g vs 142 g，p <.001）的样本重量较高，估计失血（104 mL vs 46 ml，P <.001），EL组的手术时间增加了22分钟（121分钟，99分钟，p <.001）。接受EL的患者确实需要更多的麻醉药后护理单位（20.5 vs 12.2口服吗啡同等学历，p = .033）;但是，这并没有转化为出院时规定的麻醉品数量增加。在逻辑回归方面，较高的标本重量趋于增加入院的可能性（优势比，1.04；置信区间，1.01-1.08）；但是，手术时间，麻醉后护理单位的时间，种族，体重指数，手术类型或对EL的需求没有预测SDD或入院。需要EL的MIS患者仍然可以实现SDD。 SDD是安全且可行的，而没有增加再入院，疼痛评分或外术术后与患者接触的患者接触的风险增加。
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.