Cost and efficiency of myringotomy procedures in minor procedure rooms compared to operating rooms.

OBJECTIVES: Minor pediatric surgeries performed in the minor procedure room (MPR) may be more time efficient and less costly compared to those performed in the operating room (OR). STUDY DESIGN: Retrospective review. METHODS: This was a retrospective study on cost and efficiency differences of bilateral myringotomy with tube insertions performed in the MPR versus the OR. Charts were reviewed from June 2015 to May 2017. Cost data was based on supply cost and case costing of medical personnel including nurses, aides, and anesthesia assistants. RESULTS: Two hundred eighteen patients were included in the study. The median age was 2.7 years (range: 0.8-16.7), and there were no differences in gender between locations. One hundred twenty-three patients had surgery in the MPR (56.4%), and 95 had surgery in the OR (43.6%). The median length of time in the procedure room was 11 minutes shorter for patients who underwent surgery in the MPR (12.0 minutes, range: 3.0-33.0) compared to patients in the OR (23.0 minutes, range: 11.0-52.0; P < .0001). Median hospital stay (2.0 hours vs. 4.3 hours; P < 0.0001) and median patient turnover time (6.0 minutes vs. 14.0 minutes; P < .0001) was shorter in the MPR compared to OR. The total overall cost of a myringotomy with tube insertion, including labor and supply cost, was $189.41 in the MPR compared to $468.56 in the OR, a difference of $279.15 per case. CONCLUSION: Bilateral myringotomy with tube insertions are more time and cost-efficient when performed in the MPR. This study supports the need for increased availability of MPR time for appropriate surgeries. LEVEL OF EVIDENCE: 3 Laryngoscope, 130:242-246, 2020.

Ojo clínico vs. gold standard / Trained eye vs. gold standard

OBJETIVO: Conocer el grado de correlación entre el diagnóstico clínico previo al proceso de cirugía menor y su concordancia con los resultados de anatomía patológica, al igual que conocer los datos de cirugía de escasa trascendencia clínica frente a la realmente necesaria y coste-efectiva. MATERIAL Y MÉTODO: Para ello realizamos un estudio descriptivo, observacional, retrospectivo y transversal de las actividades de cirugía menor de una consulta del Centro de Salud Ciudad Real I. RESULTADOS: Se remiten 124 piezas para su diagnóstico histológico, de las cuales los principales diagnósticos clínicos son: nevus melanocíticos intradérmicos (34,67%), queratosis seborreica (11,30%) y quistes epidermoides o sebáceos (10,48%). Se obtiene una correlación clinicopatológica del 68%. Se han seguido los protocolos del centro de trabajo para la realización de este estudio en relación con la confidencialidad de los datos. CONCLUSIONES: Analizamos estos resultados y los comparamos con otros trabajos similares realizados en el ámbito de la cirugía menor en atención primaria, pudiendo afirmar que existe una buena correlación entre el diagnóstico clínico inicial y los resultados anatomopatológicos

OBJECTIVE: To determine the degree of correlation between the clinical diagnosis prior to the minor surgery process and its concordance with the results of histopathology report, as well as to determine the surgical data of little clinical importance compared to that which is really necessary and cost-effective. MATERIAL AND METHOD: A descriptive, observational, retrospective and transversal study was conducted of the Minor Surgery Activities of a clinic in the Ciudad Real Health Centre I. RESULTS: A total of 124 surgical specimens were sent for clinical diagnostic comparison, of which, the main clinical diagnoses were: intradermal melanocytic nevi (34.67%), seborrheic keratosis (11.30%), and epidermoid or sebaceous cysts (10.48%). A correlation of 68% was obtained. The protocols of the work centre have been followed to carry out this study in relation to the confidentiality of the data. CONCLUSIONS: These results were analysed and compared with other similar works performed in the field of minor surgery in Primary Care, being able to affirm that there is a good correlation between the initial clinical diagnosis and the histopathology results

[Trained eye vs. gold standard]. / Ojo clínico vs. gold standard.

OBJECTIVE: To determine the degree of correlation between the clinical diagnosis prior to the minor surgery process and its concordance with the results of histopathology report, as well as to determine the surgical data of little clinical importance compared to that which is really necessary and cost-effective. MATERIAL AND METHOD: A descriptive, observational, retrospective and transversal study was conducted of the Minor Surgery Activities of a clinic in the Ciudad Real Health Centre I. RESULTS: A total of 124 surgical specimens were sent for clinical diagnostic comparison, of which, the main clinical diagnoses were: intradermal melanocytic nevi (34.67%), seborrheic keratosis (11.30%), and epidermoid or sebaceous cysts (10.48%). A correlation of 68% was obtained. The protocols of the work centre have been followed to carry out this study in relation to the confidentiality of the data. CONCLUSIONS: These results were analysed and compared with other similar works performed in the field of minor surgery in Primary Care, being able to affirm that there is a good correlation between the initial clinical diagnosis and the histopathology results.

The EasyTube during general anesthesia for minor surgery: A randomized, controlled trial.

BACKGROUND: The EasyTube (EzT) is a supraglottic airway device that is used for emergency airway situations. Ventilation during general anesthesia should also be feasible, but literature on the EzT is scarce. We evaluated the EzT in comparison with the endotracheal tube (ETT) in its use during general anesthesia in a comparative study. METHODS: A total of 400 patients with American Society of Anesthesiologists (ASA) physical status I to II scheduled for minor surgery in 4 centers were randomized for ventilation via the ETT or EzT. RESULTS: In all patients, the EzT and the ETT could be inserted within 3 attempts. In all EzT patients, the inspiratory and expiratory minute volumes (6.64 ±â€Š0.71 and 6.34 ±â€Š0.69 L/min) were sufficient to reach target oxygenation values, similar to ETT patients (P  =  .59). Mean peak pressure, mean plateau pressure, and mean dynamic compliance did not differ between the groups. Sore throat and blood on the cuff after removal were the most frequent complications in both groups. CONCLUSION: Ventilation for up to 1 hour during general anesthesia in patients with ASA physical status I to II with the EzT is feasible and safe.

Minor surgery in general practice and effects on referrals to hospital care: observational study.

BACKGROUND: Strengthening primary care is the focus of many countries, as national healthcare systems with a strong primary care sector tend to have lower healthcare costs. However, it is unknown to what extent general practitioners (GPs) that perform more services generate fewer hospital referrals. The objective of this study was to examine the association between the number of surgical interventions and hospital referrals. METHODS: Data were derived from electronic medical records of 48 practices that participated in the Netherlands Information Network of General Practice (LINH) in 2006-2007. For each care-episode of benign neoplasm skin/nevus, sebaceous cyst or laceration/cut it was determined whether the patient was referred to a medical specialist and/or minor surgery was performed. Multilevel multinomial regression analyses were used to determine the relation between minor surgery and hospital referrals on the level of the GP-practice. RESULTS: Referral rates differed between diagnoses, with 1.0% of referrals for a laceration/cut, 8.2% for a sebaceous cyst and 10.2% for benign neoplasm skin/nevus. The GP practices performed minor surgery for a laceration/cut in 8.9% (SD:14.6) of the care-episodes, for a benign neoplasm skin/nevus in 27.4% (SD:14.4) of cases and for a sebaceous cyst in 26.4% (SD:13.8). GP practices that performed more minor surgery interventions had a lower referral rate for patients with a laceration/cut (-0.38; 95%CI:-0.60- -0.11) and those with a sebaceous cyst (-0.42; 95%CI:-0.63- -0.16), but not for people with benign neoplasm skin/nevus (-0.26; 95%CI:-0.51-0.03). However, the absolute difference in referral rate appeared to be relevant only for sebaceous cysts. CONCLUSIONS: The effects of minor surgery vary between diagnoses. Minor surgery in general practice appears to be a substitute for specialist medical care only in relation to sebaceous cysts. Measures to stimulate minor surgery for sebaceous cysts may induce substitution.

Comportamiento del tratamiento quirúrgico de las várices de los miembros inferiores en pacientes geriátricos / Behavior of surgical treatment of lower extremities varices in geriatric patients

Las enfermedades venosas son muy frecuentes en los ancianos y, aunque no amenazan la vida, producen síntomas que pueden afectar su calidad de vida.OBJETIVOS: Caracterizar el tratamiento quirúrgico de las várices de los miembros inferiores en pacientes de 60 años y más; determinar el costo de la cirugía ambulatoria y la convencional.MÉTODOS: Se realizó un estudio descriptivo y prospectivo en el servicio de flebolinfología del Instituto Nacional de Angiología y Cirugía Vascular en el período de dos años. La muestra estuvo compuesta por 130 pacientes de 60 años y más, de uno y otro sexos, portadores de várices en los miembros inferiores que requerían ser sometidos a un tratamiento quirúrgico. Se recogieron los siguientes datos: sexo, edad, factores de riesgo, tipo de cirugía empleada, si hubo o no complicación posquirúrgica. RESULTADOS: Se encontró que 95 (73,1 por ciento) de las operaciones realizadas eran ambulatorias y 35 (26,9 por ciento) hospitalizadas. Los factores de riesgo más frecuentes fueron: las afecciones osteoarticulares, el sexo femenino, los embarazos, y la estancia de pie. La complicación posquirúrgica más observada fue el hematoma. La cirugía que más se practicó fue la resección de venas comunicantes incompetentes.CONCLUSIONES: Los pacientes geriátricos sometidos a tratamiento quirúrgico de las várices en miembros inferiores presentan una evolución clínica satisfactoria, siempre y cuando no existan patologías asociadas importantes. La cirugía ambulatoria es la más practicada y resulta más económica que la convencional(AU)

The venous diseases are very frequent in old persons and aren't a threat for life. They produce symptoms that may to affect its quality of life. OBJECTIVE: To characterize the surgical treatment of lower extremities varices in patients aged 60 and more and also to determine the ambulatory and conventional surgery cost. METHODS: A descriptive and prospective study was conducted in the phlebolymphology of the National Institute of Angiology and Vascular Surgery over two years. Sample included 130 patients aged 60 and more of both sexes presenting with lower extremities varices requiring surgical treatment. The following data were collected: sex, age, risk factors, and the type of surgery applied, as well as if there was or not a postsurgical complication. RESULTS: It was found that 95 (73,1 percent) of surgeries performed were of ambulatory type and 35 (26,9 percent ) were at hospital. The more frequent risk factors were: osteoarticular affections, female sex, pregnancies and to be standing. The more observed postsurgical complication was the hematoma and the more carried out surgery was the incompetent communicating veins resection. CONCLUSIONS: Elderly patients underwent surgical treatment of lower extremities varices have a satisfactory clinical course provided that there were not significant associated pathologies. Ambulatory surgery is the more carried out and it is of more low-cost than the conventional one(AU)

Impact of the introduction of fee for service payments on types of minor surgical procedures undertaken by general practitioners: observational study.

The 1990 general practitioners (GPs) contract introduced item of service payment for minor surgery, payable for six categories of procedure. Early review showed no substitution of cheaper procedures for more expensive treatments. Detailed payment data from six Health Authorities for the period 1993-2000 show an 11 per cent increase in claims, largely accounted for by the rise in cautery, incorporating cryotherapy. Cryotherapy is no more effective at treating warts than cheap commercially available products, but is quite profitable for GPs. This is yet another example of item of service payment distorting treatment priorities. The new GP contract, and the initiative to develop GPs with special interests in dermatology and minor surgery, will allow primary care trusts to develop minor surgery undertaken by appropriately skilled and experienced GPs, and which reflects the needs of the population.

Intravenous sedation vs general anesthesia for pediatric otolaryngology procedures.

OBJECTIVE: To compare efficacy, safety, and hospital charges for common pediatric otolaryngology procedures with the use of intravenous sedation (IVS) vs general anesthesia (GA). DESIGN: Retrospective chart study. SETTING: Hospital-based pediatric otolaryngology practice. PATIENTS: Patients younger than 18 years who underwent tympanostomy tube removal and/or patch myringoplasty with absorbable gelatin sponge, nasal ciliary biopsy, fine-needle aspiration, or other minor procedures between September 1, 1998, and August 31, 2001. INTERVENTIONS: Procedures performed in 2 settings: outpatient clinic with IVS or operating room with GA. MAIN OUTCOME MEASURES: Procedure completion rate, tympanic membrane perforation rate after ear procedures, complications, and hospital charges. RESULTS: Of 103 procedures, 54 were performed with IVS and 49 with GA. Within the GA group, 32 of 49 patients had additional operations performed and were excluded from analysis of safety and hospital charges. Procedure completion rate was 100% in both groups. The most common procedure was tympanostomy tube removal with patch myringoplasty (IVS, 52 ears; GA, 42 ears). The rate of persistent tympanic membrane perforation was similar between these groups (IVS, 7 [16%] of 45 ears; GA, 5 [15%] of 33; P =.96). All complications were minor and occurred at similar rates (IVS, 10 [19%] of 54 ears; GA, 3 [18%] of 17; P =.94). These events included hypoxia, airway obstruction, and bradycardia, all of which resolved spontaneously or responded to noninvasive interventions such as oxygen or repositioning. Average hospital charges were significantly higher for the GA group (IVS, $356.22; GA, $1516.55; P<.001). CONCLUSION: Various procedures can be performed safely, effectively, and with decreased hospital charges with the use of IVS administered by a pediatric sedation service.

Los costes de un programa de cirugía menor durante un añoen un centro de Atención Primaria de Salud / The costs of a program of minor surgery during one year in a Primary Health Care centre

Fundamentos: existen varios estudios sobre experiencias y efectividad de programas de cirugía menor (CM) en Atención Primaria (AP) pero hay mucho desconocimiento acerca de los costes de estas actividades para poder establecer comparaciones entre los diferentes niveles asistenciales y áreas geográficas. Objetivo: medir los costes de un año de práctica de CM en un centro de AP.Diseño: estudio de evaluación económica, descriptivo, retrospectivo. Material y métodos: se desarrolló en AP sobre 479 pacientes tratados con diferentes procedimientos de CM desde enero a diciembre de 1998. Se incluyeron pacientes con patologías dérmicas y de uña que recibieron procedimientos quirúrgicos programados. Se excluyeron aquéllos con lesiones dérmicas que necesitaron tratamiento inmediato, sospecha de lesión maligna, queloides previos, riesgo de lesión neurológica, alergia a anestésicos locales, tratamiento anticoagulante. Medimos por separado costes de crioterapia y costes de otros procedimientos de CM. Resultados: fueron evaluadas 336 sesiones de criocirugía en 267 pacientes con un coste total anual de 589.857 ptas. (3.545,11). El coste medio por procedimiento fue 1.755 ptas. (10,55). El coste medio por paciente fue 2.209 ptas. (13,28).También fueron evaluadas 212 sesiones de otros procedimientos de CM en 212 pacientes con un coste total anual de 1.627.228 ptas. (9.779,8). El coste medio por paciente y procedimiento fue 7.676 ptas. (46,13).Conclusiones: la falta de estudios de costes sobre CM en especializada en nuestra región impide comparar nuestros resultados. Aunque en nuestra opinión, los programas de CM en AP muestran un bajo coste, se precisa utilizar metodologías estandarizadas de evaluación económica para poder comparar resultados tanto en AP como especializada. (AU)

Trends in oral surgery in England and Wales 1991-2000.

OBJECTIVE: To investigate trends in oral surgery in England and Wales 1991-2000. METHODS: Oral surgery procedure data were derived from Dental Practice Board and Department of Health Hospital Episode Statistics. RESULTS: There was a 6% increase in minor oral surgery (MOS) procedures, including ordinary extractions, extractions of special difficulty, apicectomies and third molar removals, carried out in the General Dental Services (GDS) but the number of third molars removed fell by 32% after 1997. General anaesthetics (GA) administered in the GDS fell by 77% and the number of sedations rose 54% after 1998. There was concentration of minor oral surgery in practices: in the year 2000, 88% of practitioners carried out less than five third molar removals. In the Hospital Dental Service (HDS) there was a 98% increase in day surgery, and a 53% decrease in ordinary admissions for minor oral surgery. HDS waiting times remained constant over the ten year period. CONCLUSIONS: The principal trends were substantial decreases in apicectomies, third molar removals after 1997 and GAs after 1998; increases in extractions of special difficulty and concentration of MOS in the GODS. Numbers of ordinary extractions did not change. In the HDS there was a large shift from in-patient to daycase provision which has facilitated expansion of maxillofacial surgery. This is an important example of NHS reconfiguration. Perhaps the most important implication of these changes concerns the place of MOS in vocational training.

[Efficiency of minor surgery in primary care according to the costs]. / Eficiencia de la cirugía menor en atención primaria según el nivel de facturación.

AIM: To quantify the cost of minor surgery in our health district during a year, by examining the amounts charged. To find the degree of clinical/pathological correlation and the number of complications, as indirect indicators of quality. DESIGN: Descriptive, cross-sectional, retrospective study. SETTING: Primary care, Río Nacimiento Health District, Abla (Almería). PARTICIPANTS: The study included all those patients attended within the minor surgery programme in the year 2000, and all the procedures used (84 patients and 95 procedures). MAIN MEASUREMENTS: The variables analysed were: type of procedure and surgery, clinical/pathological correlation, early surgical complications, and cost per procedure. We calculated the cost of our activity on the basis of: a) cost occasioned at the health centre; b) what a medical insurance company would bill; c) what a primary care district would bill, and d) what a health service hospital would bill. RESULTS: 95 procedures in 84 patients were examined. 31 samples were sent to pathology with a clinical-pathological correlation of 77.42%. No complications were recorded. At our centre the cost was 817.18 euros. An insurance company would have charged 8803.63 euros; a PC district, 4852.03 euros; and a health service hospital, 14 015.39 euros. CONCLUSION: The minor surgery performed at our health centre by our team was more cost-effective than if it was performed in other public or private centres with high standards of quality.

Randomized clinical trial of the effectiveness of emergency day surgery against standard inpatient treatment.

BACKGROUND: The aim of this study was to assess the feasibility of treating patients with minor and intermediate general surgical emergency conditions as day cases. METHODS: Emergency referrals for minor and intermediate general surgical conditions were assessed by a surgeon. Those fitting day-case criteria and requiring operation under general anaesthesia were randomized to receive standard inpatient care or day surgery. Patients in the latter group were booked on to day-case lists or gaps on inpatient elective lists for surgery within 48 h. The process was coordinated by an experienced theatre sister. RESULTS: One hundred patients were randomized. There was a reduction in the number of nights spent in hospital in the day-case group (median 0 versus 2 nights; P < 0.001). The median time from diagnosis to treatment was 1 day in both groups, although there was a small but significant delay in the day-case group (P = 0.018). There was no significant difference in postoperative outcome or patient and general practitioner satisfaction. The day-case option had no increased impact on primary care services but was associated with a significant saving of about pound sterlings 150 per patient (P < 0.001). CONCLUSION: Certain general surgical emergencies may be managed as day cases with cost saving but without detriment to patient care.

Manejo de herida operatoria con apósito oclusivo / Management of operatory wounds using occlusive dressing

Con el propósito de evaluar una alternativa eficaz, sencilla y económica en el manejo de las heridas operatorias, se diseñó un estudio prospectivo y randomizado, comparando el sistema tradicional de curación de heridas, con el uso de un apósito oclusivo que se mantuvo hasta la remoción de los puntos. Ciento cinco pacientes consecutivos, con 110 heridas operatorias limpias o limpias-contaminadas, intervenidos en el Hospital de Quilpué entre junio y septiembre de 1999, se separaron en dos grupos al azar de los cuales 52 recibieron apósito oclusivo y 58 apósito tradicional. El grupo que recibió parche oclusivo tuvo un 5,8 por ciento de complicaciones locales de la herida, mientras que el grupo tradicional tuvo un 10,3 por ciento. El costo intrahospitalario fue de $100 y $2.346 respectivamente. Se demuestra la ventaja del método propuesto en relación a efectividad, costo, tiempo y confort de los pacientes

[Economic impact of the introduction of a minor surgery program in primary care]. / Impacto económico de la implantación de un programa de cirugía menor en atención primaria.

OBJECTIVE: To value the economic impact of implantation (establishment) of a minor surgery programme within health area of primary care in Albacete (Spain). SETTING: Primary care (PC). DESIGN: Observational, cross-sectional and retrospective study. Interventions and measurements. It has been recorded some patients operated on subsidiary minor surgery pathologies in the three health centers of Albacete area that participated in pilot experience from 1 November 1997 to 30 October 1998. It has been calculated the fixed costs corresponding to sanitary staff and the repayment of chirurgical area daily. As well, it were calculated the costs corresponding to disposable and not disposable equipment. It were analysed costs in function of intervention and the total cost were compared with the cost it would have supposed if it would carried out in specialized private centers according to up to dated fees of 1998 insurance companies. MAIN RESULTS: During the study interval were operated on 185 patients with an average age of 64,5 years (SD +/- 21,4) with a slight predominance of women. All pathologies treated were benign, 39 cases were abscess, 38 were nail pathology, and 35 were foreign bodies removed.Cost were calculated on the basis of time of one year. Total cost of minor surgery programme were 1.234.440 Pts (7715 Euros) whereas if it would have carried out at specialized level it supposed between 2621450 Pts (15755.23 Euros) and 4440000 Pts (26684.94 Euros). CONCLUSION: In our study, the minor surgery programme in primary care diminish the cost in comparison with private specialized level, at the same time as reducing standby list in specialities like surgery or dermatology.

[What is the cost of excision-suture of a skin lesion under local anesthesia? 2-month prospective evaluation in a public sector hospital]. / Combien coûte l'exérèse-suture d'une lésion cutanée sous anesthésie locale? Evaluation prospective sur deux mois en secteur hospitalier public.

The purpose of this study was to assess the cost of a minimal surgical operation: skin surgery under local anesthesia in the outpatients department. A two-month prospective study was carried out on 149 operations, with a mean duration of 33 minutes. The mean cost of the operation was 434 FF. Although this study is very specific and its results cannot be generalized, it gives a method and an order of magnitude. It shows that it is difficult to save money without decreasing the quality of the operation. The price list of the French national health care system, and the price of the surgeon himself are discussed.

General practitioners as providers of minor surgery--a success story?

BACKGROUND: It is now recognized that many minor surgical procedures can be appropriately performed in a general practitioner setting; the government has introduced a list of minor operations, for which it is prepared to pay a limited fee, and it is now time to see whether this service can be expanded. AIM: To demonstrate that a group of general practitioners (GPs) with a particular interest in minor surgery can offer an expanded service both to their own patients and also to the patients of neighbouring colleagues, whether fundholding or non-fundholding, within a health authority area. METHOD: The West Kent Health Authority awarded a contract for 500 minor operations to a group practice of five GPs. At the end of the first year, 511 operations had been performed, and the results and implications are discussed. RESULTS: The target of 500 minor operations was met and passed in the first year. Thirty-five neighbouring GPs referred their patients directly. All were offered an initial appointment within one week and had their operation performed within one month, unless they had expressed a preference for an alternative date. Several unsuspected malignancies were discovered-no complications were recorded, patients' and referring doctors' satisfaction was high and the scheme was judged to have been a success in their eyes. CONCLUSION: GPs can provide an efficient, cost-effective minor surgery service, which is popular with patients and referring colleagues. Whether this is the way we wish to organize minor surgery in the future needs further discussion.