RESUMO
BACKGROUND: Current German legislation ( (section sign) 115 b SGB V) allows groin hernia inpatient treatment only under particular circumstances. That allows the operative technique of first choice for outpatient groin hernia repair to be determined by basic market principles. The aim of this paper was to study the feasibility of outpatient minimally invasive hernia surgery with regard to complication rates, patient satisfaction, and economic considerations. METHODS: For 1 year, a total of 571 patients with inguinal hernias (131 male, eight female, mean age 46 years, all ASA I) were treated at two surgical centers. Twenty-four percent (139/571) underwent outpatient total extraperitoneal repair (TEP). Complication rates were recorded. Patient satisfaction with the procedure was evaluated by a standard questionnaire. Cost calculations were compared with revenues according to the EBM2000plus. RESULTS: Of the patients, 96.4% were discharged on the day of operation without subsequent rehospitalization, 84% had no fears of complications at home, 54% went back to work in less than 14 days, and 88.7% were willing to undergo TEP a second time if necessary. Calculated average total cost of euro 709 exceeded the revenue of euro 565 by 20%. CONCLUSION: For a carefully selected group, outpatient TEP is patient-friendly and safe. Despite these advantages, it still remains economically unattractive to hospital management because of the 20% cover shortage. Improvements in the current legislation are urgently desired.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/legislação & jurisprudência , Hérnia Inguinal/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Avaliação de Resultados em Cuidados de Saúde/legislação & jurisprudência , Adulto , Procedimentos Cirúrgicos Ambulatórios/economia , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Custos e Análise de Custo , Feminino , Alemanha , Custos de Cuidados de Saúde/legislação & jurisprudência , Custos de Cuidados de Saúde/estatística & dados numéricos , Hérnia Inguinal/economia , Hérnia Inguinal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/economia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Admissão do Paciente/economia , Admissão do Paciente/legislação & jurisprudência , Admissão do Paciente/estatística & dados numéricos , Satisfação do Paciente , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , ReoperaçãoRESUMO
The toxicity of the mixture NIAX-ESN which contains 95% dimethylaminopropionitrile was evaluated in male rats. Large doses (2.0 ml/kg ip) rapidly produced CNS excitation followed by depression and death. The mixture (given orally as two doses of 0.31 or 0.62 ml/kg respectively) induced acute urinary bladder lesions in 3 days. The changes consisted of massive transmural edema, acute ulcers and inflammation and, occassionally hemorrhagic necrosis of the bladder wall.
