Послеоперационное лечение

Renal cancer. Contemporary management. Editor John A. Libertino. Springer New York, 2013

Postoperative management


Postoperatively, patients are admitted to the medical surgical floor and continued on intravenous fluids. Pain control is managed with intermittent intravenous analgesics. Laboratory data is checked postoperatively and the following morning. Perioperative antibiotics are continued for 24 h. For deep vein thrombosis prevention, sequential compression devices are worn at all times and early ambulation is encouraged. The following morning, patients are started on a clear liquid diet and ureteral stent is removed. Once tolerating liquids, analgesic medications are given orally. The drain is monitored for output, and if high, fluid is checked for creatinine. If drain output remains low, the Foley catheter is then removed and the drain is removed prior to discharge from the hospital. On average, length of hospitalization is 2.2 days at our institution. Patients advance diet as tolerated once they have evidence of bowel function. Shah and Abaza presented their clinical pathway for discharging patients on postoperative day 1 following robotic partial nephrectomy. In their series of 90 patients, 94% (n = 85) were discharged on postoperative day 1 with a readmission rate of 5% (n = 4). Minimal data exists, but in our empiric experience, antiplatelet agents can be safely resumed in 10 days.

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