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5.
Cir. Esp. (Ed. impr.) ; 100(3): 115-124, mar. 2022. ilus, tab, ^graf
Article de Espagnol | IBECS | ID: ibc-203003

RÉSUMÉ

La situación actual de la pandemia por SARS-CoV-2 tiene paralizada la cirugía no urgente y/u oncológica en muchos hospitales de nuestro país con lo que esto conlleva para la salud de los ciudadanos que están pendientes de una intervención quirúrgica. La cirugía mayor ambulatoria puede abarcar en su cartera de servicios más del 85% de los procedimientos quirúrgicos que se realizan en un servicio de cirugía y se presenta como una alternativa factible y segura en el momento actual ya que no requiere camas de ingreso y disminuye claramente el riesgo de infección. Además, es la herramienta que debería generalizarse para solucionar la acumulación de pacientes en lista de espera que la pandemia está generando, por lo que parece oportuno que desde la sección de Cirugía Mayor Ambulatoria de la Asociación Española de Cirujanos se presente una serie de recomendaciones para la implementación de la misma en estas circunstancias excepcionales que nos toca vivir.(AU)


The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.(AU)


Sujet(s)
Humains , Procédures de chirurgie ambulatoire/normes , Infections à coronavirus/prévention et contrôle , Pandémies , Chirurgiens , Consensus
6.
Anaesthesia ; 77(3): 277-285, 2022 Mar.
Article de Anglais | MEDLINE | ID: mdl-34530496

RÉSUMÉ

We used the Hospital Episodes Statistics database to investigate unwarranted variation in the rates Trusts discharged children the same day after scheduled tonsillectomy and associations with adverse postoperative outcomes. We included children aged 2-18 years who underwent tonsillectomy between 1 April 2014 and 31 March 2019. We stratified analyses by category of Trust, non-specialist or specialist, defined as without or with paediatric critical care facilities, respectively. We adjusted analyses for age, sex, year of surgery and aspects of presentation and procedure type. Of 101,180 children who underwent tonsillectomy at non-specialist Trusts, 62,926 (62%) were discharged the same day, compared with 24,138/48,755 (50%) at specialist Trusts. The adjusted proportion of children discharged the same day as tonsillectomy ranged from 5% to 100% at non-specialist Trusts and 9% to 88% at specialist Trusts. Same-day discharge was not independently associated with an increased rate of 30-day emergency re-admission at non-specialist Trusts but was associated with a modest rate increase at specialist Trusts; adjusted probability 8.0% vs 7.7%, odds ratio (95%CI) 1.14 (1.05-1.24). Rates of adverse postoperative outcomes were similar for Trusts that discharged >70% children the same day as tonsillectomy compared with Trusts that discharged <50% children the same day, for both non-specialist and specialist Trust categories. We found no consistent evidence that day-case tonsillectomy is associated with poorer outcomes. All Trusts, but particularly specialist centres, should explore reasons for low day-case rates and should aim for rates >70%.


Sujet(s)
Procédures de chirurgie ambulatoire/tendances , Sortie du patient/tendances , Sécurité des patients , Médecine d'État/tendances , Amygdalectomie/tendances , Adolescent , Procédures de chirurgie ambulatoire/normes , Enfant , Enfant d'âge préscolaire , Angleterre/épidémiologie , Femelle , Humains , Mâle , Sortie du patient/normes , Sécurité des patients/normes , Complications postopératoires/diagnostic , Complications postopératoires/épidémiologie , Médecine d'État/normes , Amygdalectomie/normes , Résultat thérapeutique
9.
Best Pract Res Clin Anaesthesiol ; 35(3): 415-424, 2021 Oct.
Article de Anglais | MEDLINE | ID: mdl-34511229

RÉSUMÉ

The growth of office-based surgery (OBS) has been due to ease of scheduling and convenience for patients; office-based anesthesia safety continues to be well supported in the literature. In 2020, the Coronavirus Disease 19 (COVID-19) has resulted in dramatic shifts in healthcare, especially in the office-based setting. The goal of closing the economy was to flatten the curve, impacting office-based and ambulatory practices. Reopening of the economy and the return to ambulatory surgery and OBS and procedures have created a challenge due to COVID-19 and the infectious disease precautions that must be taken. Patients may be more apt to return to the outpatient setting to avoid the hospital, especially with the resurgence of COVID-19 cases locally, nationally, and worldwide. This review provides algorithms for screening and testing patients, selecting patients for procedures, choosing appropriate procedures, and selecting suitable personal protective equipment in this unprecedented period.


Sujet(s)
Procédures de chirurgie ambulatoire/normes , Anesthésie/normes , COVID-19/prévention et contrôle , Soins aux patients/normes , Équipement de protection individuelle/normes , Guides de bonnes pratiques cliniques comme sujet/normes , Procédures de chirurgie ambulatoire/tendances , Anesthésie/tendances , COVID-19/épidémiologie , Humains , Soins aux patients/tendances , Équipement de protection individuelle/tendances
10.
Front Endocrinol (Lausanne) ; 12: 717427, 2021.
Article de Anglais | MEDLINE | ID: mdl-34394008

RÉSUMÉ

Background: Outpatient thyroid surgery is gaining popularity as it can reduce length of hospital stay, decrease costs of care, and increase patient satisfaction. There remains a significant variation in the use of this practice including a perceived knowledge gap with regards to the safety of outpatient thyroidectomies and how to go about implementing standardized institutional protocols to ensure safe same-day discharge. This review summarizes the information available on the subject based on existing published studies and guidelines. Methods: This is a scoping review of the literature focused on the safety, efficacy and patient satisfaction associated with outpatient thyroidectomies. The review also summarizes and editorializes the most recent American Thyroid Association guidelines. Results: In total, 11 studies were included in the analysis: 6 studies were retrospective analyses, 3 were retrospective reviews of prospective data, and 2 were prospective studies. The relative contraindications to outpatient thyroidectomy have been highlighted, including: complex medical conditions, anticipated difficult surgical dissection, patients on anticoagulation, lack of home support, and patient anxiety toward an outpatient procedure. Utilizing these identified features, an outpatient protocol has been proposed. Conclusion: The salient features regarding patient safety and selection criteria and how to develop a protocol implementing ambulatory thyroidectomies have been identified and reviewed. In conclusion, outpatient thyroidectomy is safe, associated with high patient satisfaction and decreased health costs when rigorous institutional protocols are established and implemented. Successful outpatient thyroidectomies require standardized preoperative selection, clear discharge criteria and instructions, and interprofessional collaboration between the surgeon, anesthetist and same-day nursing staff.


Sujet(s)
Procédures de chirurgie ambulatoire/normes , Durée du séjour/statistiques et données numériques , Patients en consultation externe/statistiques et données numériques , Maladies de la thyroïde/chirurgie , Thyroïdectomie/méthodes , Études de faisabilité , Humains , Maladies de la thyroïde/anatomopathologie
11.
Ann R Coll Surg Engl ; 103(7): 496-498, 2021 Jul.
Article de Anglais | MEDLINE | ID: mdl-34192485

RÉSUMÉ

As the COVID-19 pandemic progressed across the UK and Northern Ireland in March 2020, our otolaryngology department began to make preparations and changes in practice to accommodate for potentially large numbers of patients with COVID-19 related respiratory illness in the hospital. We retrospectively reviewed the number of non-elective admissions to our department between the months of January and May in 2019 and 2020. A significant reduction in admissions of up to 94% during the months of the pandemic was observed. Our practice shifted to manage patients with epistaxis and peritonsillar abscess on an outpatient basis, and while prospectively collecting data on this, we did not observe any significant adverse events. We view this as a positive learning point and change in our practice as a result of the COVID-19 pandemic.


Sujet(s)
Procédures de chirurgie ambulatoire/tendances , COVID-19/prévention et contrôle , Procédures de chirurgie oto-rhino-laryngologique/tendances , Admission du patient/tendances , Département hospitalier de chirurgie/tendances , Procédures de chirurgie ambulatoire/normes , Procédures de chirurgie ambulatoire/statistiques et données numériques , COVID-19/épidémiologie , COVID-19/transmission , Épistaxis/chirurgie , Humains , Prévention des infections/normes , Irlande du Nord/épidémiologie , Procédures de chirurgie oto-rhino-laryngologique/normes , Procédures de chirurgie oto-rhino-laryngologique/statistiques et données numériques , Pandémies/prévention et contrôle , Admission du patient/normes , Admission du patient/statistiques et données numériques , Abcès périamygdalien/chirurgie , Études rétrospectives , Département hospitalier de chirurgie/normes , Département hospitalier de chirurgie/statistiques et données numériques
12.
Ann R Coll Surg Engl ; 103(7): 478-480, 2021 Jul.
Article de Anglais | MEDLINE | ID: mdl-34192500

RÉSUMÉ

BACKGROUND: There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. METHODS: We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. RESULTS: There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. CONCLUSIONS: There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.


Sujet(s)
Procédures de chirurgie ambulatoire/mortalité , COVID-19/épidémiologie , Interventions chirurgicales non urgentes/mortalité , Traitement d'urgence/mortalité , Procédures de chirurgie ambulatoire/normes , Procédures de chirurgie ambulatoire/statistiques et données numériques , COVID-19/complications , COVID-19/diagnostic , COVID-19/transmission , Dépistage de la COVID-19/normes , Dépistage de la COVID-19/statistiques et données numériques , Interventions chirurgicales non urgentes/normes , Interventions chirurgicales non urgentes/statistiques et données numériques , Service hospitalier d'urgences/normes , Service hospitalier d'urgences/statistiques et données numériques , Traitement d'urgence/normes , Traitement d'urgence/statistiques et données numériques , Angleterre/épidémiologie , Femelle , Mortalité hospitalière , Humains , Incidence , Prévention des infections/normes , Prévention des infections/statistiques et données numériques , Durée du séjour/statistiques et données numériques , Mâle , Pandémies/prévention et contrôle , Pandémies/statistiques et données numériques , Admission du patient/normes , Admission du patient/statistiques et données numériques , Études rétrospectives , SARS-CoV-2/isolement et purification , Médecine d'État/normes , Médecine d'État/statistiques et données numériques
13.
Orthop Clin North Am ; 52(3): 201-208, 2021 Jul.
Article de Anglais | MEDLINE | ID: mdl-34053565

RÉSUMÉ

Based on a series of 407 outpatient total hip arthroplasties performed by a single surgeon, a standardized protocol for blood loss management in outpatient arthroplasty was developed consisting of a presurgical hematocrit of greater than 36%, administration of tranexamic acid, prophylactic introduction of albumin, hypotensive epidural anesthesia, monopolar electrocautery, and bipolar sealer. This protocol uses techniques that alone are not novel but together create a standardized and reproducible pathway that when implemented can increase the safety of outpatient hip arthroplasty.


Sujet(s)
Procédures de chirurgie ambulatoire/méthodes , Arthroplastie prothétique de hanche/méthodes , Perte sanguine peropératoire/prévention et contrôle , Adulte , Sujet âgé , Procédures de chirurgie ambulatoire/normes , Antifibrinolytiques/usage thérapeutique , Arthroplastie prothétique de hanche/normes , Électrocoagulation , Femelle , Humains , Mâle , Adulte d'âge moyen , Acide tranéxamique/usage thérapeutique , Jeune adulte
14.
Laryngoscope ; 131(11): 2610-2615, 2021 11.
Article de Anglais | MEDLINE | ID: mdl-33979452

RÉSUMÉ

OBJECTIVE: Standardization of postoperative care using clinical care guidelines (CCG) improves quality by minimizing unwarranted variation. It is unknown whether CCGs impact patient throughput in outpatient adenotonsillectomy (T&A). We hypothesize that CCG implementation is associated with decreased postoperative length of stay (LOS) in outpatient T&A. METHODS: A multidisciplinary team was assembled to design and implement a T&A CCG. Standardized discharge criteria were established, including goal fluid intake and parental demonstration of medication administration. An order set was created that included a hard stop for discharge timeframe with choices "meets criteria," "4-hour observation," and "overnight stay." Consensus was achieved in June 2018, and the CCG was implemented in October 2018. Postoperative LOS for patients discharged the same day was tracked using control chart analysis with standard definitions for centerline shift being utilized. Trends in discharge timeframe selection were also followed. RESULTS: Between July 2015 and August 2017, the average LOS was 4.82 hours. This decreased to 4.39 hours in September 2017 despite no known interventions and remained stable for 17 months. After CCG implementation, an initial trend toward increased LOS was followed by centerline shifts to 3.83 and 3.53 hours in March and October 2019, respectively. Selection of the "meets criteria" discharge timeframe increased over time after CCG implementation (R2  = 0.38 P = .003). CONCLUSIONS: Implementation of a CCG with standardized discharge criteria was associated with shortened postoperative LOS in outpatient T&A. Concurrently, surgeons shifted practice to discharge patients upon meeting criteria rather than after a designated timeframe. LEVEL OF EVIDENCE: NA Laryngoscope, 131:2610-2615, 2021.


Sujet(s)
Adénoïdectomie/statistiques et données numériques , Procédures de chirurgie ambulatoire/statistiques et données numériques , Soins postopératoires/normes , Guides de bonnes pratiques cliniques comme sujet , Amygdalectomie/statistiques et données numériques , Adénoïdectomie/normes , Adolescent , Procédures de chirurgie ambulatoire/normes , Enfant , Enfant d'âge préscolaire , Femelle , Humains , Nourrisson , Durée du séjour/statistiques et données numériques , Durée du séjour/tendances , Mâle , Sortie du patient/normes , Études rétrospectives , Amygdalectomie/normes
15.
Plast Reconstr Surg ; 147(5): 1087-1095, 2021 05 01.
Article de Anglais | MEDLINE | ID: mdl-33835086

RÉSUMÉ

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic has widely affected rhinosurgery, given the high risk of contagion and the elective nature of the aesthetic procedure, generating many questions on how to ensure safety. The Science and Research Committee of the Rhinoplasty Society of Europe aimed at preparing consensus recommendations on safe rhinosurgery in general during the COVID-19 pandemic by appointing an international panel of experts also including delegates of The Rhinoplasty Society. METHODS: A Zoom meeting was performed with a panel of 14 international leading experts in rhinosurgery. During 3.5 hours, four categories of questions on preoperative safety measures in private practice and outpatient clinics, patient assessment before and during surgery, and legal issues were presented by four chairs and discussed by the expert group. Afterward, the panelists were requested to express an online, electronic vote on each category and question. The panel's recommendations were based on current evidence and expert opinions. The resulting report was circulated in an iterative open e-mail process until consensus was obtained. RESULTS: Consensus was obtained in several important points on how to safely restart performing rhinosurgery in general. Preliminary recommendations with different levels of agreement were prepared and condensed in a bundle of safety measures. CONCLUSION: The implementation of the panel's recommendations may improve safety of rhinoplasty by avoiding operating on nondetected COVID-19 patients and minimizing severe acute respiratory syndrome coronavirus 2 virus spread in outpatient clinics and operating rooms.


Sujet(s)
COVID-19/prévention et contrôle , Prévention des infections/normes , Transmission de maladie infectieuse du patient au professionnel de santé/prévention et contrôle , Soins préopératoires/normes , Rhinoplastie/normes , Établissements de soins ambulatoires/organisation et administration , Établissements de soins ambulatoires/normes , Procédures de chirurgie ambulatoire/normes , COVID-19/épidémiologie , COVID-19/transmission , Congrès comme sujet , Consensus , Interventions chirurgicales non urgentes/normes , Humains , Prévention des infections/organisation et administration , Pandémies/prévention et contrôle , Chirurgiens , Communication par vidéoconférence
16.
Laryngoscope ; 131(7): E2352-E2355, 2021 07.
Article de Anglais | MEDLINE | ID: mdl-33427321

RÉSUMÉ

OBJECTIVE/HYPOTHESIS: Variability exists in the postoperative disposition of children following Sistrunk procedures. Management options include discharge home versus overnight observation, with the latter allowing monitoring for immediate postoperative complications, presumably reducing the need for subsequent readmission. This study investigates the association between overnight observation and ambulatory management of children undergoing Sistrunk procedures and relevant postoperative complication and revisit rates to clarify best practice for these patients. METHODS: This was a retrospective database review using the Pediatric Health Information System database from 2007 to 2016. RESULTS: The cited dataset identified 6,434 qualifying patients, categorized into ambulatory versus overnight observation cohorts. The overall 30-day revisit rate was 4.9%; the revisit rate with overnight observation (6.1%) was higher than for ambulatory patients (3.8%, adjusted odds ratio (OR) 1.60; 95% confidence interval (CI): 1.21, 2.12). Revisit rates were significantly higher in patients 2 years of age or younger compared to older patients (6.7% vs. 4.3%). The rates of return to the operating room for the observation versus ambulatory groups were 1.8% and 0.5%, respectively. Cervical fluid collection and neck swelling were among the most common revisit indications in both groups, with a mean time to presentation of 9 days. CONCLUSIONS: This study demonstrates that ambulatory management following a Sistrunk procedure is not associated with increased rates of common postoperative complications, readmission, or need for secondary surgical intervention. A Sistrunk procedure may be safely performed on an ambulatory basis in select cases. LEVEL OF EVIDENCE: IV Laryngoscope, 131:E2352-E2355, 2021.


Sujet(s)
Procédures de chirurgie ambulatoire/effets indésirables , Procédures de chirurgie oto-rhino-laryngologique/effets indésirables , Complications postopératoires/épidémiologie , Guides de bonnes pratiques cliniques comme sujet , Kyste thyréoglosse/chirurgie , Adolescent , Procédures de chirurgie ambulatoire/normes , Procédures de chirurgie ambulatoire/statistiques et données numériques , Enfant , Enfant d'âge préscolaire , Jeux de données comme sujet , Femelle , Humains , Nourrisson , Durée du séjour/statistiques et données numériques , Mâle , Procédures de chirurgie oto-rhino-laryngologique/normes , Admission du patient/statistiques et données numériques , Sortie du patient/normes , Sortie du patient/statistiques et données numériques , Réadmission du patient/statistiques et données numériques , Complications postopératoires/diagnostic , Complications postopératoires/étiologie , Période postopératoire , Études rétrospectives
18.
Medicine (Baltimore) ; 100(1): e23995, 2021 Jan 08.
Article de Anglais | MEDLINE | ID: mdl-33429761

RÉSUMÉ

ABSTRACT: The Chinese government is attaching great importance to the development of ambulatory surgery in order to optimize the healthcare system in China. The study aims to examine the complications and quality indicators of patients who underwent gynecological ambulatory surgery at a tertiary hospital in China.This was a retrospective study of patients who underwent ambulatory surgery between July and September 2019 at the Department of Gynecology of the First Affiliated Hospital of Shandong First Medical University. The patients were followed by phone at 30 days after discharge. The postoperative complications, mortality, unplanned re-operation, delayed discharge, unplanned re-hospitalization, and patient satisfaction were collected. The patients who underwent conventional hysteroscopic resection of uterine lesions during the same period were collected as controls for the economics analysis.A total of 392 patients who underwent ambulatory gynecological surgery were included. Fifteen patients had postoperative complications, and the total complication rate was 3.8% (15/392). Eight (8/392, 2.0%) patients had delayed discharge. There were no unplanned re-operations and deaths. There were two (2/392, 0.5%) cases of unplanned re-hospitalization. At 30 days after discharge, two patients were dissatisfied, and 390 cases were satisfied, for an overall satisfaction rate of 99.5%. Compared with conventional hysteroscopic resection of uterine lesions, ambulatory hysteroscopic surgery had a shorter hospital stay and lower total costs (P < .05) but similar surgery-related costs.Ambulatory gynecological surgery is feasible in China, with an acceptable complication profile and obvious economic and social benefits. Nevertheless, hospital management shall be reinforced.


Sujet(s)
Procédures de chirurgie gynécologique/méthodes , Adulte , Procédures de chirurgie ambulatoire/méthodes , Procédures de chirurgie ambulatoire/normes , Procédures de chirurgie ambulatoire/tendances , Chine/épidémiologie , Études de faisabilité , Femelle , Procédures de chirurgie gynécologique/normes , Procédures de chirurgie gynécologique/tendances , Humains , Adulte d'âge moyen , Complications postopératoires/épidémiologie , Complications postopératoires/étiologie , Mise au point de programmes/méthodes , Études rétrospectives
19.
PLoS One ; 16(1): e0245774, 2021.
Article de Anglais | MEDLINE | ID: mdl-33497408

RÉSUMÉ

BACKGROUND/OBJECTIVES: This study aimed to study one-month recovery profile and to identify predictors of Quality of Recovery (QOR) after painful day surgery and investigate the influence of pain therapy on QOR. METHODS/DESIGN: This is a secondary analysis of a single-centre, randomised controlled trial of 200 patients undergoing ambulatory haemorrhoid surgery, arthroscopic shoulder or knee surgery, or inguinal hernia repair between January 2016 and March 2017. Primary endpoints were one-month recovery profile and prevalence of poor/good QOR measured by the Functional Recovery Index (FRI), the Global Surgical Recovery index and the EuroQol questionnaire at postoperative day (POD) 1 to 4, 7, 14 and 28. Multiple logistic regression analysis was performed to determine predictors of QOR at POD 7, 14, and 28. Differences in QOR between pain treatment groups were analysed using the Mann-Whitney U test. RESULTS: Four weeks after haemorrhoid surgery, inguinal hernia repair, arthroscopic knee and arthroscopic shoulder surgery, good QOR was present in 71%, 76%, 57% and 24% respectively. Poor QOR was present in 5%, 0%, 7% and 29%, respectively. At POD 7 and POD 28, predictors for poor/intermediate QOR were type of surgery and a high postoperative pain level at POD 4. Male gender was another predictor at POD 7. Female gender and having a paid job were also predictors at POD 28. Type of surgery and long term fear of surgery were predictors at POD 14. No significant differences in total FRI scores were found between the two different pain treatment groups. CONCLUSIONS: The present study shows a procedure-specific variation in recovery profile in the 4-week period after painful day surgery. The best predictors for short-term (POD 7) and long-term (POD 28) poor/intermediate QOR were a high postoperative pain level at POD 4 and type of surgery. Different pain treatment regimens did not result in differences in recovery profile. TRIAL REGISTRATION: European Union Clinical Trials Register 2015-003987-35.


Sujet(s)
Procédures de chirurgie ambulatoire/effets indésirables , Interventions chirurgicales non urgentes/effets indésirables , Douleur postopératoire/épidémiologie , Mesures des résultats rapportés par les patients , Adulte , Sujet âgé , Procédures de chirurgie ambulatoire/normes , Interventions chirurgicales non urgentes/normes , Femelle , Humains , Mâle , Adulte d'âge moyen , Douleur postopératoire/psychologie , Satisfaction des patients
20.
J Pediatr Orthop ; 41(1): e85-e89, 2021 Jan.
Article de Anglais | MEDLINE | ID: mdl-32852367

RÉSUMÉ

BACKGROUND: The purpose of this study was to determine the intraoperative and 30-day postoperative complication rates in a large consecutive cohort of pediatric patients who had orthopaedic surgery at a freestanding ambulatory surgery center (ASC). The authors also wanted to identify the rates of same-day, urgent hospital transfers, and 30-day hospital admissions. The authors hypothesized that pediatric orthopaedic procedures at a freestanding ASC can be done safely with a low rate of complications. METHODS: A retrospective review identified patients aged 17 years or younger who had surgery at a freestanding ASC over a 9-year period. Adverse outcomes were divided into intraoperative complications, postoperative complications, need for the secondary procedure, unexpected hospital admission on the same day of the procedure, and unexpected hospital admission within 30 days of the index procedure. Complications were graded as grade 1, the complication could be treated without additional surgery or hospitalization; grade 2, the complication resulted in an unplanned return to the operating room (OR) or hospital admission; or grade 3, the complication resulted in an unplanned return to the OR or hospitalization with a change in the overall treatment plan. RESULTS: Adequate follow-up was available for 3780 (86.1%) surgical procedures. Overall, there were 9 (0.24%) intraoperative complications, 2 (0.08%) urgent hospital transfers, 114 (3%) complications, and 16 (0.42%) readmissions. Seven of the 9 intraoperative complications resolved before leaving the OR, and 2 required return to the OR.Neither complications nor hospitalizations correlated with age, race, gender, or length or type of surgery. There was no correlation between the presence of medical comorbidities, body mass index, or American Society of Anesthesiologists score and complication or hospitalization. CONCLUSIONS: Pediatric orthopaedic surgical procedures can be performed safely in an ASC because of multiple factors that include dedicated surgical teams, single-purpose ORs, and strict preoperative screening criteria. The rates of an emergency hospital transfer, surgical complications, and 30-day readmission, even by stringent criteria, are lower than those reported for outpatient procedures performed in the hospital setting. LEVEL OF EVIDENCE: Level IV-case series.


Sujet(s)
Établissements de soins ambulatoires , Procédures de chirurgie ambulatoire , Procédures orthopédiques , Complications postopératoires , Adolescent , Établissements de soins ambulatoires/organisation et administration , Établissements de soins ambulatoires/normes , Procédures de chirurgie ambulatoire/effets indésirables , Procédures de chirurgie ambulatoire/méthodes , Procédures de chirurgie ambulatoire/normes , Études de cohortes , Femelle , Humains , Mâle , Procédures orthopédiques/effets indésirables , Procédures orthopédiques/méthodes , Procédures orthopédiques/normes , Évaluation des résultats et des processus en soins de santé , Complications postopératoires/épidémiologie , Complications postopératoires/étiologie , Études rétrospectives , États-Unis/épidémiologie
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