PDF(Pubmed)
Abstract：
UNASSIGNED: This study aims to evaluate the feasibility and safety of planned postoperative day 1 discharge (PPOD1) among patients who undergo laparotomy (XL) in the department of gynecology oncology utilizing a modified enhanced recovery after surgery (ERAS) protocol including opioid-sparing anesthesia (OSA) and defined discharge criteria.
UNASSIGNED: Patients undergoing XL and minimally invasive surgery (MIS) were enrolled in this prospective, observational cohort study after the departmental implementation of a modified ERAS protocol. The primary outcome was quality of life (QoL) using SF36, PROMIS GI, and ICIQ-FLUTS at baseline and 2- and 6-week postoperative visits. Statistical significance was assessed using the two-tailed Student\'s t-test and non-parametric Mann-Whitney two-sample test.
UNASSIGNED: Of the 141 subjects, no significant demographic differences were observed between the XL group and the MIS group. The majority of subjects, 84.7% (61), in the XL group had gynecologic malignancy [vs. MIS group; 21 (29.2%), p < 0.001]. All patients tolerated OSA. The XL group required higher intraoperative opioids [7.1 ± 9.2 morphine milligram equivalents (MME) vs. 3.9 ± 6.9 MME, p = 0.02] and longer surgical time (114.2 ± 41 min vs. 96.8 ± 32.1 min, p = 0.006). No significant difference was noted in the opioid requirements at the immediate postoperative phase and the rest of the postoperative day (POD) 0 or POD 1. In the XL group, 69 patients (73.6%) were successfully discharged home on POD1. There was no increase in the PROMIS score at 2 and 6 weeks compared to the preoperative phase. The readmission rates within 30 days after surgery (XL 4.2% vs. MIS 1.4%, p = 0.62), rates of surgical site infection (XL 0% vs. MIS 2.8%, p = 0.24), and mean number of post-discharge phone calls (0 vs. 0, p = 0.41) were comparable between the two groups. Although QoL scores were significantly lower than baseline in four of the nine QoL domains at 2 weeks post-laparotomy, all except physical health recovered by the 6-week time point.
UNASSIGNED: PPOD1 is a safe and feasible strategy for XL performed in the gynecologic oncology department. PPOD1 did not increase opioid requirements, readmission rates compared to MIS, and patient-reported constipation and nausea/vomiting compared to the preoperative phase.
UNASSIGNED: Patients undergoing XL and minimally invasive surgery (MIS) were enrolled in this prospective, observational cohort study after the departmental implementation of a modified ERAS protocol. The primary outcome was quality of life (QoL) using SF36, PROMIS GI, and ICIQ-FLUTS at baseline and 2- and 6-week postoperative visits. Statistical significance was assessed using the two-tailed Student\'s t-test and non-parametric Mann-Whitney two-sample test.
UNASSIGNED: Of the 141 subjects, no significant demographic differences were observed between the XL group and the MIS group. The majority of subjects, 84.7% (61), in the XL group had gynecologic malignancy [vs. MIS group; 21 (29.2%), p < 0.001]. All patients tolerated OSA. The XL group required higher intraoperative opioids [7.1 ± 9.2 morphine milligram equivalents (MME) vs. 3.9 ± 6.9 MME, p = 0.02] and longer surgical time (114.2 ± 41 min vs. 96.8 ± 32.1 min, p = 0.006). No significant difference was noted in the opioid requirements at the immediate postoperative phase and the rest of the postoperative day (POD) 0 or POD 1. In the XL group, 69 patients (73.6%) were successfully discharged home on POD1. There was no increase in the PROMIS score at 2 and 6 weeks compared to the preoperative phase. The readmission rates within 30 days after surgery (XL 4.2% vs. MIS 1.4%, p = 0.62), rates of surgical site infection (XL 0% vs. MIS 2.8%, p = 0.24), and mean number of post-discharge phone calls (0 vs. 0, p = 0.41) were comparable between the two groups. Although QoL scores were significantly lower than baseline in four of the nine QoL domains at 2 weeks post-laparotomy, all except physical health recovered by the 6-week time point.
UNASSIGNED: PPOD1 is a safe and feasible strategy for XL performed in the gynecologic oncology department. PPOD1 did not increase opioid requirements, readmission rates compared to MIS, and patient-reported constipation and nausea/vomiting compared to the preoperative phase.
摘要：
■本研究旨在评估在妇科肿瘤科进行剖腹手术（XL）的患者中，计划术后第1天出院（PPOD1）的可行性和安全性，采用改良的增强术后恢复（ERAS）方案，包括阿片类药物保留麻醉（OSA）和定义的出院标准。
■接受XL和微创手术（MIS）的患者参加了这项前瞻性研究，部门实施修改后的ERAS方案后的观察性队列研究。主要结果是使用SF36、PROMISGI、基线和术后2周和6周的ICIQ-FLUTS。使用双尾Studentt检验和非参数Mann-Whitney双样品检验评估统计显著性。
■在141个科目中，XL组和MIS组之间没有观察到显著的人口统计学差异.大多数主题，84.7%(61)，XL组患有妇科恶性肿瘤[vs.MIS组；21（29.2%），p<0.001]。所有患者均耐受OSA。XL组需要更高的术中阿片类药物[7.1±9.2吗啡毫克当量（MME）与3.9±6.9MME，p=0.02]和更长的手术时间（114.2±41分钟vs.96.8±32.1min,p=0.006)。术后即刻阶段和术后当天（POD）0或POD1的其余时间，阿片类药物的需求量没有显着差异。在XL组中，69例患者（73.6%）在POD1上成功出院。与术前相比，2周和6周的PROMIS评分没有增加。术后30天内的再入院率(XL4.2%与MIS1.4%，p=0.62),手术部位感染率(XL0%vs.MIS2.8%，p=0.24)，以及出院后电话呼叫的平均次数(0与0，p=0.41）在两组之间具有可比性。尽管在剖腹手术后2周，9个QoL域中的4个QoL评分明显低于基线，除身体健康外，所有在6周时间点恢复。
■PPOD1是在妇科肿瘤科进行XL的安全可行的策略。PPOD1没有增加阿片类药物的需求，再入院率与管理信息系统相比，和患者报告的便秘和恶心/呕吐与术前相比。
■接受XL和微创手术（MIS）的患者参加了这项前瞻性研究，部门实施修改后的ERAS方案后的观察性队列研究。主要结果是使用SF36、PROMISGI、基线和术后2周和6周的ICIQ-FLUTS。使用双尾Studentt检验和非参数Mann-Whitney双样品检验评估统计显著性。
■在141个科目中，XL组和MIS组之间没有观察到显著的人口统计学差异.大多数主题，84.7%(61)，XL组患有妇科恶性肿瘤[vs.MIS组；21（29.2%），p<0.001]。所有患者均耐受OSA。XL组需要更高的术中阿片类药物[7.1±9.2吗啡毫克当量（MME）与3.9±6.9MME，p=0.02]和更长的手术时间（114.2±41分钟vs.96.8±32.1min,p=0.006)。术后即刻阶段和术后当天（POD）0或POD1的其余时间，阿片类药物的需求量没有显着差异。在XL组中，69例患者（73.6%）在POD1上成功出院。与术前相比，2周和6周的PROMIS评分没有增加。术后30天内的再入院率(XL4.2%与MIS1.4%，p=0.62),手术部位感染率(XL0%vs.MIS2.8%，p=0.24)，以及出院后电话呼叫的平均次数(0与0，p=0.41）在两组之间具有可比性。尽管在剖腹手术后2周，9个QoL域中的4个QoL评分明显低于基线，除身体健康外，所有在6周时间点恢复。
■PPOD1是在妇科肿瘤科进行XL的安全可行的策略。PPOD1没有增加阿片类药物的需求，再入院率与管理信息系统相比，和患者报告的便秘和恶心/呕吐与术前相比。
