ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
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Turkish Journal of Reproductive Medicine and Surgery

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ORİJİNAL ARAŞTIRMALAR

Laparoskopik Histerektomi Sonrası Erken Taburculuk: 6 Aylık Sonuçlar ve Komplikasyonlar
Early Discharge After Laparoscopic Hysterectomy: Six Month Trial of Outcomes and Complications
Received Date : 26 Jun 2022
Accepted Date : 01 Dec 2022
Available Online : 15 Dec 2022
Doi: 10.24074/tjrms.2022-92145 - Makale Dili: EN
TJRMS. 2022;6(2):145-51
ÖZET
Amaç: Jinekolojik nedenlerle ameliyat olan hastalar erken taburculuktan birçok yönden faydalanırlar. Literatürde artan kanıtlar, benign nedenlerle ameliyat olan hastalarda aynı gün taburcu olmanın minimal invaziv cerrahi için güvenli olduğunu göstermektedir. Bu çalışmanın birincil amacı, hastaya tercihini sorarak erken taburcu olmanın kabul edilebilirliğini değerlendirmekti. .İkincil amaç olarak postoperatif komplikasyon ve hastaneye yatış oranlarını “erken taburculuk ve “geciktirilmiş taburculuk” grupları arasında karşılaştırmaktı. Gereç ve Yöntemler: Bu çalışma prospektif randomize olmayan kontrollü bir klinik çalışma olarak dizayn edildi. Üniversite Hastanesinde “erken” taburcu olmaya uygun görülen, laparoskopik histerektomi yapılan hastalar değerlendirildi. Erken taburculuk açısından uygunluk bir “checklist”e göre belirlendi. Bu çalışmanın birincil amacı, hastaları isterlerse 24 saat içinde taburcu olabilecekleri veya daha uzun süre kalabilecekleri konusunda bilgilendirdikten sonra erken taburcu olmanın kabul edilebilirlik oranını belirlemekti. Bulgular: Ekim 2021 - Nisan 2022 tarihleri arasında bölümümüzde toplam 275 adet laparoskopik histerektomi yapıldı. Çalışmaya dahil edilme kriterlerini karşılamayan hastalar elendikten sonra 194 hasta bir kontrol listesi kullanılarak taburcu edilmeye uygun bulundu. Bunların 96'sı (%49,5) 24 saat önce taburcu olmayı tercih ederken, 98 hasta (%50,5) 24 saatten fazla kalmayı tercih etti. Gruplar yaş, VKİ, klinik ve cerrahi özellikler açısından analiz edildiğinde sonuçlar benzerdi. İki grup arasında istatistiksel olarak anlamlılığa ulaşan tek etkili değişken operasyon süresiydi. Yeniden hastaneye yatış oranımız erken taburculuk grubunda % 1.04, geç taburculuk grubunda % 1.02 idi. Sonuç: Komplikasyon ve tekrar başvuru oranlarının düşük olması nedeniyle eve erken taburculuk güvenli kabul edilse de hastalarımızın yarısından fazlası bunu tercih etmemiştir.”Ev vizitleri” ve hemşirelik hizmetlerinin iyileştirilmesinin “erken taburculuk” kabulünü arttıracağına inanıyoruz.
ABSTRACT
Objective: The gynecologic patient benefits from early discharge in many ways. A growing evidence of literature suggests that same-day discharge is safe for minimally invasive hysterectomy for benign indications.The primary outcome was the acceptability rate of early discharge after informing patients that if they wish they can be discharged from the hospital within 24 hours or they might stay longer. The secondary outcomes were to evaluate the 30 day emergency department and hospital readmission rates between same-day discharge and delayed discharge after laparoscopic hysterectomy in an academic referral centre. Material and Methods: This is an observational non-randomised prospective clinical trial. Patients who underwent laparoscopic hysterectomy at an hospital deemed “fit for discharge” were evaluated. Variables including patient comorbidities and other details were prospectively collected for each patient. Postoperative outcomes were followed for 30 days following the operation utilizing the hospital’s central medical record system.All patients were scheduled for postoperative 1 month control to account for any other hospital visits or admissions besides our centre. Results: From October 2021 to April 2022, a total of 275 laparoscopic hysterectomies were performed at our department. After exclusion criteria 194 patients were deemed fit for discharge using a check-list. 96 (49.5 %) of these preffered to be discharged before 24 hours while the slight majority of 98 patients (50.5 %) opted to stay over 24 hours. The groups were similar with regards to age, BMI, clinical and surgical characteristics. The only effective variable reaching statistical significance between the two groups was the duration of the operation. Our readmisson rate was 1.04 % in the early discharge group and 1.02 % in the late discharge group. Conclusion: Duration of surgery was the sole variable effecting patient preference of early discharge. There was no difference in complications or 30- day emergency department visits in either group. Even though it was considered safe to be early discharged to home, as evident by low complication and readmission rates, more than half of our patients did not prefer to do so. Promoting nursing staff and home based visits may increase the acceptability of early discharge.
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