■为了评估可行性,安全,以及全面区域计划的有效性,包括微创康复和授权护理(MIREC)途径,可以显着减少腹腔镜胃切除术后的住院时间,而不会增加不良事件。
成本效益和改善患者预后对于在全球范围内提供高质量的胃癌护理至关重要。
■比较2012年2月至2023年3月在综合医疗保健系统内使用2种不同护理模式进行胃癌手术的结果。主要终点是住院时间。次要终点是需要重症监护病房,急诊室(ER)访问,重新接纳,再操作,手术后30天内死亡。
■有553名患者,前(2012年2月至2016年4月)为167,后MIREC时期(2016年5月至2023年3月)为386。围手术期化疗利用率从31.7%上升至76.4%(P<0.0001)。腹腔镜胃切除术从17.4%增加到97.7%(P<0.0001)。住院时间从7天减少到2天(P<0.0001),分别有32.1%和88%的患者在术后第1天和术后第2天出院回家。当比较之前和之后的MIREC时,重症监护病房利用率(10.8%与2.9%,P<0.0001),急诊室就诊(34.7%与19.7%,P=0.0002),和再入院(18.6%与11.1%,P=0.019)在30天也相当低。此外,更多患者接受术后辅助化疗(31.4%至63.5%,P<0.0001),胃切除术和开始辅助化疗之间的时间也更短(49-41天;P=0.002)。
■这个全面的区域计划,其中包括区域化护理,腹腔镜入路,现代肿瘤治疗,外科亚专业化,和MIREC通路,可以潜在地改善胃癌手术的结果。这些益处包括减少住院时间和降低并发症发生率。因此,这个项目可以彻底改变胃癌手术的实施方式,导致更高质量的护理和增加对患者的价值。
UNASSIGNED: To evaluate the feasibility, safety, and effectiveness of a comprehensive regional program, including the Minimally Invasive Recovery and Empowerment Care (MIREC) pathway, that can significantly reduce hospital stays after laparoscopic gastrectomy without increasing adverse events.
UNASSIGNED: Cost-effectiveness and improving patient outcomes are crucial in providing quality gastric cancer care worldwide.
UNASSIGNED: To compare the outcomes of gastric cancer surgery using 2 different models of care within an integrated healthcare system from February 2012 to March 2023. The primary endpoint was the length of hospital stay. The secondary endpoints were the need for intensive care unit care, emergency room (ER) visits, readmission, reoperation, and death within 30 days after surgery.
UNASSIGNED: There were 553 patients, 167 in the pre-(February 2012-April 2016) and 386 in the post-MIREC period (May 2016-March 2023). Perioperative chemotherapy utilization increased from 31.7% to 76.4% (P < 0.0001). Laparoscopic gastrectomy increased from 17.4% to 97.7% (P < 0.0001). Length of hospitalization decreased from 7 to 2 days (P < 0.0001), with 32.1% and 88% of patients discharged home on postoperative day 1 and postoperative day 2, respectively. When comparing pre- and post-MIREC, intensive care unit utilization (10.8% vs. 2.9%, P < 0.0001), ER visits (34.7% vs. 19.7%, P = 0.0002), and readmission (18.6% vs. 11.1%, P = 0.019) at 30 days were also considerably lower. In addition, more patients received postoperative adjuvant chemotherapy (31.4% to 63.5%, P < 0.0001), and the time between gastrectomy and starting adjuvant chemotherapy was also less (49-41 days; P = 0.002).
UNASSIGNED: This comprehensive regional program, which encompasses regionalization care, laparoscopic approach, modern oncologic care, surgical subspecialization, and the MIREC pathway, can potentially improve gastric cancer surgery outcomes. These benefits include reduced hospital stays and lower complication rates. As such, this program can revolutionize how gastric cancer surgery is delivered, leading to a higher quality of care and increased value to patients.