背景:结肠和直肠手术中增强恢复途径(ERPs)的发展已导致针对选定患者的当日出院(SDD)程序的发展。2003年首次描述了分流回肠造口术(DLI)闭合后的早期排出。然而,它的广泛采用仍然有限,根据美国外科医生学会国家外科质量改进计划数据库,在2005-2006年,SDD仅占所有DLI关闭的3.2%,到2016年上升到4.1%。本研究旨在比较SDDDLI闭合与标准ERP后DLI闭合的结果。
方法:一项回顾性病例匹配研究比较了125例接受SDDDLI封堵的患者与250例接受DLI封堵的患者的年龄(±1岁)标准ERP后,性别,美国麻醉医师协会评分,身体质量指数,手术日期(±2个月),潜在的疾病,和医院现场。主要结果是比较30天并发症发生率。
结果:传统ERP组的患者接受了更多的术中液体(1221.1±416.6对1039.0±368.3mL,P<.001),但估计失血量相似。SDD-ERP组中有10名患者(8%)未通过SDD。SDD组术后30天并发症发生率(14.8%)明显低于标准ERP组(25.7%,P=.025)。这种差异主要是由于SDD组肠梗阻发生率较低(9.6%vs14.8%,P=.034)。再入院率没有显着差异(SDD-ERP的9.6%与标准ERP的9.2%,P=.900)和再操作率(SDD-ERP的3.2%与标准ERP的2.4%,P=.650)。
结论:SDD回肠造口术闭合是安全的,可行,与本研究的标准ERP相比,与较少的并发症相关的有效程序。这可以代表一种新的护理标准。需要进一步的前瞻性试验来证实这项研究的结果。
BACKGROUND: The evolution of enhanced recovery pathways (ERPs) in colon and rectal surgery has led to the development of same-day discharge (SDD) procedures for selected patients. Early discharge after diverting loop ileostomy (DLI) closure was first described in 2003. However, its widespread adoption remains limited, with SDD accounting for only 3.2% of all DLI closures in 2005-2006, according to the American College of Surgeons National Surgical Quality Improvement Program database, and rising to just 4.1% by 2016. This study aimed to compare the outcomes of SDD DLI closure with those of DLI closure after the standard ERP.
METHODS: A retrospective case-matched study compared 125 patients undergoing SDD DLI closure with 250 patients undergoing DLI closure after the standard ERP based on age (±1 year), sex, American Society of Anesthesiologists score, body mass index, surgery date (±2 months), underlying disease, and hospital site. The primary outcome was comparative 30-day complication rates.
RESULTS: Patients in the traditional ERP group received more intraoperative fluids (1221.1 ± 416.6 vs 1039.0 ± 368.3 mL, P < .001) but had similar estimated blood loss. Ten patients (8%) in the SDD-ERP group failed SDD. The 30-day postoperative complication rate was significantly lower in the SDD group (14.8%) than the standard ERP group (25.7%, P = .025). This difference was primarily driven by a lower incidence of ileus in the SDD group (9.6% vs 14.8%, P = .034). There were no significant differences in readmission rate (9.6% of SDD-ERP vs 9.2% of standard ERP, P = .900) and reoperation rates (3.2% of SDD-ERP vs 2.4% of standard ERP, P = .650).
CONCLUSIONS: SDD ileostomy closure is a safe, feasible, and effective procedure associated with fewer complications than the present study\'s standard ERP. This could represent a new standard of care. Further prospective trials are required to confirm the findings of this study.