加速康复外科模式下成人腹股沟疝修补术日归手术的应用效果分析

Analysis of the application effect of same-day surgery mode in adult patients with inguinal hernia repair under enhanced recovery after surgery mode

目的 探讨加速康复外科模式下开展成人腹股沟疝修补术日归手术的应用效果。方法 回顾性分析2020年8月-2022年3月在四川大学华西医院日间手术中心行成人腹股沟疝修补术患者的围手术期资料。将接受常规日间手术的成人腹股沟疝修补术患者作为对照组(常规组),将接受日归手术的成人腹股沟疝修补术患者作为试验组(日归组)。对比分析2组患者的安全性、费用和患者体验感3个方面的差异。结果 共纳入患者319例,其中常规组152例,日归组167例。2组患者的性别、文化程度、职业、疝环直径差异无统计学意义(P>0.05),日归组患者的年龄比常规组大[(49.49±12.88)vs.(46.41±14.12)岁,P<0.05]。2组患者的疝位置均以右侧居多,但疝位置存在差异(P<0.05)。安全性指标方面,2组患者的麻醉方式均以局部麻醉居多,日归组的局部麻醉比例(98.2%vs. 76.3%)、术中出血量[2.8(2.0,5.0)vs. 1.3(0.0,5.0)mL]高于常规组,日归组的手术时间[25.2(20.0,33.0)vs. 32.3(26.0,40.7)min]短于常规组(P<0.05)。2组的术后下床活动时间、术后3 d和28 d并发症发生率差异无统计学意义(P>0.05)。2组均无术中并发症发生。费用指标方面,2组的住院费差异无统计学意义(P>0.05)。日归组的手术费高于常规组[1 472.0(1 438.1,1 614.6)vs. 1 450.3(1 428.1,1 438.1)元,P<0.05],药费[109.2(81.3,138.7)vs. 255.8(127.0,261.6)元]和总医疗费用[8 418.5(8 207.4,9 129.9)vs. 8 912.1(8 325.9,9 177.9)元]低于常规组(P<0.05)。患者体验感指标方面,日归组的术后疼痛评分[0.3(0.0,1.0)vs. 0.2(0.0,0.0)分]和满意度评分[3.3(3.0,4.0)vs. 3.0(3.0,3.0)分]均高于常规组(P<0.05)。结论 成人腹股沟疝修补术日归手术方式与常规手术方式均具有较高的安全性,但日归手术方式相比常规手术方式更加经济,患者满意度更高,提示加速康复外科模式下开展成人腹股沟疝修补术日归手术可行且安全经济,进一步优化与提升了日间手术医疗服务内容与质量。

Objective To explore the application effect of same-day surgery mode in adult patients with inguinal hernia repair under enhanced recovery after surgery mode. Methods The perioperative data of adults undergoing inguinal hernia repair in the Day Surgery Center of West China Hospital, Sichuan University between August 2020 and March 2022 were analyzed retrospectively. The adult patients with inguinal hernia repair who received routine daytime surgery were taken as the control group(routine group), and the adult patients with inguinal hernia repair who received same-day surgery were selected as the trial group(same-day group). The differences in safety, cost and patient experience between the two groups were compared and analyzed. Results A total of 319 patients were included, including 152 in the routine group and 167 in the same-day group. There was no significant difference in gender, education level,occupation and hernia ring diameter between the two groups(P>0.05). The age of the patients in the same-day group was older than that in the routine group [(49.49±12.88) vs.(46.41±14.12) years, P<0.05]. The hernia position of the two groups was mostly on the right side, but there was a difference in the hernia position(P<0.05). In terms of safety indicators, the majority of patients in the two groups used local anesthesia. The proportion of local anesthesia(98.2% vs. 76.3%), the amount of intraoperative bleeding [2.8(2.0, 5.0) vs. 1.3(0.0, 5.0) mL] in the same-day group were higher than those in the routine group, and the operation time [25.2(20.0, 33.0) vs. 32.3(26.0, 40.7) min] in the same-day group was shorter than that in the routine group(P<0.05). There was no significant difference between the two groups in the time of getting out of bed and the complications rate on the 3rd and 28th days after operation(P>0.05). There were no intraoperative complications in both groups. In terms of cost indicators, there was no significant difference between the two groups in the hospitalization cost(P>0.05). The surgery cost of the same-day group was higher than that of the routine group [1 472.0(1 438.1, 1 614.6) vs. 1 450.3(1 428.1, 1 438.1) yuan, P<0.05]. The drug cost [109.2(81.3, 138.7) vs. 255.8(127.0, 261.6)yuan] and the total medical cost [8 418.5(8 207.4, 9 129.9) vs. 8 912.1(8 325.9, 9 177.9) yuan] in the same-day group were lower than those in the routine group(P<0.05). In terms of patient experience indicators, the postoperative pain score [0.3(0.0, 1.0) vs. 0.2(0.0, 0.0)] and satisfaction score [3.3(3.0, 4.0) vs. 3.0(3.0, 3.0)] of the same-day group were higher than those of the routine group(P<0.05). Conclusion Both the same-day surgery mode and the routine surgery mode of adult patients with inguinal hernia repair have high safety, but the same-day surgery mode is more economical and patient satisfaction is higher than the routine surgery mode, which suggest that the same-day surgery mode of adult patients with inguinal hernia repair under enhanced recovery after surgery mode is feasible, safe and economic, and further optimizes and improves the content and quality of daytime surgical medical services.