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首页> 外文期刊>Surgical Endoscopy >Appropriate patient selection facilitates safe discharge from the PACU after laparoscopic ventral hernia repair: an analysis of the AHSQC database
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Appropriate patient selection facilitates safe discharge from the PACU after laparoscopic ventral hernia repair: an analysis of the AHSQC database

机译：适当的患者选择有助于从腹腔镜腹疝修复后的PACU安全放电：AHSQC数据库的分析

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Background The postoperative management of patients undergoing laparoscopic ventral hernia repair (VHR) remains relatively unknown. The purpose of our study was to determine if patient and hernia-specific factors could be used to predict the likelihood of hospital admission following laparoscopic VHR using the Americas Hernia Society Quality Collaborative (AHSQC) database. Methods All patients who underwent elective, laparoscopic VHR with mesh placement from October 2015 through April 2019 were identified within the AHSQC database. Patients without clean wounds, those with chronic liver disease, and those without 30-day follow-up data were excluded from our analysis. Patient and hernia-specific variables were compared between patients who were discharged from the post-anesthesia care unit (PACU) and patients who required hospital admission. Comparisons were also made between the two groups with respect to 30-day morbidity and mortality events. Results A total of 1609 patients met inclusion criteria; 901 (56%) patients were discharged from the PACU. The proportion of patients discharged from the PACU increased with each subsequent year. Several patient comorbidities and hernia-specific factors were found to be associated with postoperative hospital admission, including older age, repair of a recurrent hernia, a larger hernia width, longer operative time, drain placement, and use of mechanical bowel preparation. Patients who required hospital admission were more likely than those discharged from the PACU to be readmitted to the hospital within 30 days (4% vs. 2%, respectively) and to experience a 30-day morbidity event (18% vs. 8%, respectively). Conclusions Patient- and hernia-specific factors can be used to identify patients who can be safely discharged from the PACU following laparoscopic VHR. Additional studies are needed to determine if appropriate patient selection for discharge from the PACU leads to decreased healthcare costs for laparoscopic VHR over the long-term.
机译：背景：腹腔镜腹疝修补术（VHR）患者的术后处理仍然相对未知。我们的研究目的是利用美国疝气协会质量协作数据库（AHSQC），确定患者和疝气特异性因素是否可用于预测腹腔镜VHR术后入院的可能性。方法在AHSQC数据库中确定2015年10月至2019年4月期间，所有接受选择性腹腔镜VHR加网片置入术的患者。没有干净伤口的患者、慢性肝病患者和没有30天随访数据的患者被排除在我们的分析之外。比较从麻醉后护理单元（PACU）出院的患者和需要入院的患者之间的患者和疝气特异性变量。还对两组之间的30天发病率和死亡率事件进行了比较。结果1609例符合纳入标准；901名（56%）患者从PACU出院。从PACU出院的患者比例逐年增加。研究发现，一些患者共病和疝气特异性因素与术后入院有关，包括年龄较大、复发性疝气的修复、更大的疝气宽度、更长的手术时间、引流管放置和使用机械肠道准备。需要入院的患者比从PACU出院的患者更有可能在30天内再次入院（分别为4%和2%），并经历30天的发病率事件（分别为18%和8%）。结论患者和疝气特异性因素可用于确定腹腔镜VHR术后可以安全出院的患者。需要进行更多的研究，以确定从PACU出院时选择合适的患者是否会降低腹腔镜VHR的长期医疗成本。

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