针对良性适应症的门诊微创子宫切除术:系统回顾

IF 1.7 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Journal of gynecology obstetrics and human reproduction Pub Date : 2024-05-24 DOI:10.1016/j.jogoh.2024.102804
Shahzia Lambat Emery , Emilien Jeannot , Patrick Dällenbach , Patrick Petignat , Jean Dubuisson
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引用次数: 0

摘要

背景妇科门诊手术可在不影响患者安全和满意度的前提下提供降低成本、方便患者和优化医院床位等优势。随着 2000 年以来医疗成本的持续上升,门诊手术可能是改善财政资源利用率的一条途径,也是在冠状病毒疾病 2019 年大流行等危机期间继续治疗患者的一种解决方案。目的本系统性综述概述了良性适应症微创门诊子宫切除术的相关文献。方法使用 PubMed 和谷歌学术搜索引擎对 2018 年至 2022 年间有关良性适应症妇科门诊手术的医学文献进行了重点系统性综述。然后,我们将选择范围缩小至涉及子宫切除术的文章。当日成功出院(SDD)的定义是患者在手术当天就能回家,无需过夜。大部分研究(n = 11)在美国进行。门诊手术的平均成功率为 60%,平均再入院率为 3%。SDD 失败的主要原因是患者的选择、排尿失败、需要止痛、恶心或呕吐或两者兼有,以及手术时间较晚。与住院治疗相比,SDD与更多并发症和再入院无关。预测 SDD 的三个主要因素是年龄小、手术时间早和手术总时间短。患者对 SDD 的绝对满意度和相对住院满意度都很高。为了提高门诊治疗的成功率,必须精心挑选患者,并提前规划手术路径。实施强化的恢复方案可能有助于促进良性适应症的门诊子宫切除术。
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Minimally invasive outpatient hysterectomy for a benign indication: A systematic review

Background

Outpatient surgery in gynaecology may offer advantages including cost reduction, patient convenience and hospital bed optimisation without compromising patient safety and satisfaction. With the continual rise in health costs since 2000, outpatient surgery could be a line of action to improve financial resource utilisation and a solution for continuing to treat patients during crises such as the coronavirus disease 2019 pandemic.

Objective

This systematic review provides an overview of the literature on minimally invasive outpatient hysterectomy for benign indications.

Method

A focused systematic review of the medical literature between 2018 and 2022 on outpatient gynaecological surgery for a benign indication was conducted using the PubMed and Google Scholar search engines. We then narrowed our selection to articles that referred to hysterectomy. Successful same-day discharge (SDD) was defined as the patient's return home on the day of the procedure without an overnight stay.

Results

Fifteen articles that focused on minimally invasive surgery were included in this review. Most of the studies (n = 11) were conducted in the United States. Outpatient surgery had a mean success rate of 60 % and a mean readmission rate of 3 %. The main reasons for SDD failure were patient choice, failed voiding, the need for pain management, nausea or vomiting, or both and the late timing of surgery. SDD was not associated with more complications and readmissions compared with inpatient care. The three main attribute predictors of SDD were young age, early timing of surgery and short total operative time. Patient satisfaction with SDD was high in absolute terms and relative to satisfaction with hospitalisation.

Conclusion

Minimally invasive outpatient hysterectomy for a benign indication is feasible and safe but is associated with a notable risk of failure. To increase the success rate of outpatient management, patients must be well selected and surgery pathways must be planned in advance. The implementation of enhanced recovery protocols may help promote outpatient hysterectomy for a benign indication.

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来源期刊
Journal of gynecology obstetrics and human reproduction
Journal of gynecology obstetrics and human reproduction Medicine-Obstetrics and Gynecology
CiteScore
3.70
自引率
5.30%
发文量
210
审稿时长
31 days
期刊介绍: Formerly known as Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Journal of Gynecology Obstetrics and Human Reproduction is the official Academic publication of the French College of Obstetricians and Gynecologists (Collège National des Gynécologues et Obstétriciens Français / CNGOF). J Gynecol Obstet Hum Reprod publishes monthly, in English, research papers and techniques in the fields of Gynecology, Obstetrics, Neonatology and Human Reproduction: (guest) editorials, original articles, reviews, updates, technical notes, case reports, letters to the editor and guidelines. Original works include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses.
期刊最新文献
Editorial board Contents New reference charts for fetal ultrasound corpus callosum length with emphasis on the third trimester High-risk patient profiles for ovarian cancer: A new approach using cluster analysis of tumor markers Partners experiences of caesarean deliveries in the operating room
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