结直肠术后24小时;系统回顾

Q4 Medicine Journal of Coloproctology Pub Date : 2023-09-01 DOI:10.1055/s-0043-1773783
Bo P. Smalbroek, Inger-Lise Schuffel, Teus J. Weijs, Lea M. Dijksman, Floris B. Poelmann, Niels A.T. Wijffels, Djamila Boerma, Anke B. Smits
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引用次数: 0

摘要

术后增强恢复的引入导致24小时出院路径增加,例如在腹腔镜胆囊切除术和减肥手术中。然而,在结直肠手术中的实施仍需起步。本系统综述从目前文献中再入院和并发症的角度评估结直肠手术24小时出院的安全性和可行性。次要结果是确定与24小时出院成功相关的因素。方法检索Pubmed和EMBASE数据库,以确定调查结直肠手术24小时出院的研究,不受研究类型的限制。搜索策略包括与门诊管理和结直肠手术相关的关键词。根据未成年人评分对研究进行评分。结果本系统综述纳入13项研究,包括6项前瞻性研究和7项回顾性研究。纳入的前瞻性研究的参与者数量从5到157不等。24小时出院组中位出院成功率为96%。所有前瞻性研究显示,24小时出院与常规术后处理的再入院率和并发症发生率相似。与24小时出院成功相关的因素是ASA分级低、年龄小、微创入路和相对较短的手术时间。结论基于回顾性和前瞻性研究,结直肠手术24小时出院似乎是可行和安全的。仔细选择患者和建立明确和充分的方案是确保安全性和可行性的关键项目。由于异质性,对结果的解释应谨慎。为了证实结果,需要一项足够有力的前瞻性随机研究。
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Twenty-four Hours Stay After Colorectal Surgery; A Systematic Review
Abstract Introduction The introduction of Enhanced Recovery After Surgery led to increasing twenty-four hours discharge pathways, for example in laparoscopic cholecystectomy and bariatric surgery. However, implementation in colorectal surgery still must set off. This systematic review assesses safety and feasibility of twenty-four hours discharge in colorectal surgery in terms of readmission and complications in current literature. Secondary outcome was identification of factors associated with success of twenty-four hours discharge. Methods Pubmed and EMBASE databases were searched to identify studies investigating twenty-four hours discharge in colorectal surgery, without restriction of study type. Search strategy included keywords relating to ambulatory management and colorectal surgery. Studies were scored according to MINORS score. Results Thirteen studies were included in this systematic review, consisting of six prospective and seven retrospective studies. Number of participants of the included prospective studies ranged from 5 to 157. Median success of discharge was 96% in the twenty-four hours discharge group. All prospective studies showed similar readmission and complication rates between twenty-four hours discharge and conventional postoperative management. Factors associated with success of twenty-four hours discharge were low ASA classification, younger age, minimally invasive approach, and relatively shorter operation time. Conclusions Twenty-four hours discharge in colorectal surgery seems feasible and safe, based on retro- and prospective studies. Careful selection of patients and establishment of a clear and adequate protocol are key items to assure safety and feasibility. Results should be interpreted with caution, due to heterogeneity. To confirm results, an adequately powered prospective randomized study is needed.
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来源期刊
Journal of Coloproctology
Journal of Coloproctology Medicine-Gastroenterology
CiteScore
0.60
自引率
0.00%
发文量
41
审稿时长
47 weeks
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