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1.
Medicine (Baltimore) ; 100(1): e23995, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429761

RESUMO

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.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Adulto , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/normas , Procedimentos Cirúrgicos Ambulatórios/tendências , China/epidemiologia , Estudos de Viabilidade , Feminino , Procedimentos Cirúrgicos em Ginecologia/normas , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Desenvolvimento de Programas/métodos , Estudos Retrospectivos
2.
Plast Reconstr Surg ; 146(2): 437-446, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740603

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has confronted the U.S. health care system with unprecedented challenges amidst a tenuous economic environment. As inpatient hospitals across the country prepare for an overwhelming influx of highly contagious COVID-19 cases, many nonemergent procedures have been cancelled or indefinitely postponed without guidance regarding eventual safe accommodation of these procedures in the future. Given the potentially prolonged impact of the COVID-19 pandemic on health care use, it is imperative for plastic surgeons to collaborate with other medical and surgical specialties to develop surge capacity protocols that allow continuation of safe, high-quality, nonemergent procedures. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Regionalização/organização & administração , Capacidade de Resposta ante Emergências/organização & administração , Cirurgia Plástica/organização & administração , Procedimentos Cirúrgicos Ambulatórios/normas , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Procedimentos Cirúrgicos Eletivos/normas , Humanos , Controle de Infecções/normas , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Reconstrutivos/normas , Regionalização/normas , Cirurgia Plástica/normas , Centros Cirúrgicos/organização & administração , Centros Cirúrgicos/normas , Telemedicina/organização & administração , Telemedicina/normas , Estados Unidos
3.
J Clin Nurs ; 29(17-18): 3541-3552, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32614105

RESUMO

AIMS AND OBJECTIVES: To describe the views on the needs of health specialists to consider when developing a digital gaming solution for children and families in a paediatric day surgery. BACKGROUND: Children's day surgery treatment is often cancelled at the last minute for various reasons, for example due to the lack of information. Digital gaming solutions could help families to be better oriented to the coming treatment. Despite the increasing demands for mHealth systems, there is not enough evidence-based information from the health specialist perspective for developing a digital gaming solution. DESIGN: A qualitative descriptive study was conducted. METHODS: Health specialists (N = 15) including 11 nurses, one physiotherapist and four doctors from different areas from one university hospital in Finland were recruited using a snowball sampling method. Semi-structured, face-to-face interviews were conducted in March and April 2019. The data were analysed using inductive conduct analyses. The COREQ checklist was used to report the data collection, analysis and the results. RESULTS: The data yielded 469 open codes, 21 sub-categories, three upper categories and one main category. The main category the digital gaming solution to support knowledge, care and guidance in children's day surgery included three upper categories: (a) support for preoperative information and guidance, (b) support for intra-operative information and care, and (c) support for postoperative information, care and guidance. CONCLUSION: Digital gaming solutions could be used to help children and families to be better prepared for upcoming treatments, to support communication in different languages and to improve children's pain management after operations. RELEVANCE TO CLINICAL PRACTICE: Evidence-based information is important to ensure that future digital solutions answer the real needs of the staff and patients. There is a need for families and children's views to be taken into consideration when developing digital gaming solutions in the hospital context.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Manejo da Dor/métodos , Pediatria/organização & administração , Jogos de Vídeo , Criança , Feminino , Finlândia , Humanos , Masculino , Relações Profissional-Família , Pesquisa Qualitativa
5.
J Urol ; 204(5): 956-961, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32379565

RESUMO

PURPOSE: We assessed the multi-institutional safety of same day discharge for robot-assisted radical prostatectomy within a single health care system. MATERIALS AND METHODS: We included 358 patients undergoing planned same day discharge for robot-assisted radical prostatectomy at 6 French centers. Primary outcomes were same day discharge failure, and 30-day complication and readmission rates. Secondary outcomes included preoperative characteristics, perioperative parameters, Chung score and pain visual analogue scale at discharge, pathological features and followup. RESULTS: Mean patient age was 64.7 years. Mean operative time and blood loss were 147.5 minutes and 228 ml, respectively. Concomitant lymph node dissection and nerve sparing procedures were performed in 43% and 62% of cases, respectively. No patient required transfusion or conversion. The same day discharge failure, complication and readmission rates were 4.2%, 16.8% and 2.8%, respectively. The most frequent complications were low grade complications including urinary infection (6.4%) and ileus (2.8%). Blood loss, lymph node dissection and pain visual analogue scale were significantly correlated with same day discharge failure. Same day discharge failure was reported in 7.8% of patients with pelvic lymph node dissection compared with only 1.5% of patients who did not undergo lymph node dissection (p=0.003). ASA® score was the only factor significantly associated with postoperative complications (p=0.023). The only factor correlated with readmission was the pain visual analogue scale at discharge (p=0.017). CONCLUSIONS: This first multi-institutional evaluation confirms the safety of same day discharge robot-assisted radical prostatectomy in a single health care system and identifies for the first time factors associated with same day discharge failure and readmission. These findings may help physicians anticipate ideal same day discharge candidates and adapt postoperative followup.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada/normas , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/normas , Estudos de Viabilidade , França , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Excisão de Linfonodo/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Próstata/cirurgia , Prostatectomia/métodos , Prostatectomia/normas , Prostatectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/normas , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
6.
World Neurosurg ; 139: e859-e863, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32450309

RESUMO

BACKGROUND: The coronavirus 2019 (COVD-19) pandemic has drastically disrupted the delivery of neurosurgical care, especially for the already at-risk neuro-oncology population. The sudden change to clinic visits has rapidly spurned the implementation of telemedicine. A recommendation care paradigm of neuro-oncologic patients limited by telemedicine has not been reported. METHODS: A summary of a multi-institution experience detailing the potential benefits, pitfalls, and the necessary considerations to outpatient care of neurosurgical oncology patients. RESULTS: There are limitations and advantages to incorporating telemedicine into the outpatient care of neuro-oncology patients. Telemedicine-specific considerations for each step and stakeholder of the appointment (physician, patient, scheduling, previsit, imaging, and physical examination) are examined. CONCLUSIONS: Telemedicine, pushed to prominence during this COVID-19 pandemic, is a powerful and possibly preferential tool for the future of outpatient neuro-oncologic care.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/tendências , Betacoronavirus , Infecções por Coronavirus/cirurgia , Oncologia/tendências , Neurocirurgia/tendências , Pneumonia Viral/cirurgia , Telemedicina/tendências , Procedimentos Cirúrgicos Ambulatórios/normas , Infecções por Coronavirus/epidemiologia , Previsões , Humanos , Oncologia/normas , Neurocirurgia/normas , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/normas
8.
Int J Gynaecol Obstet ; 149(3): 269-272, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32270477

RESUMO

In the context of the COVID-19 pandemic, patients need to be evaluated within 2-4 weeks in the following cases: cytology result of "squamous cell carcinoma," "atypical glandular cells, favor neoplastic," "endocervical adenocarcinoma in situ," or "adenocarcinoma"; histopathological diagnosis of suspected invasion from cervical/vaginal biopsy, or invasive disease after a cervical excision procedure, vaginal excision, or vulvar biopsy/excision; sudden onset of strongly suggestive symptoms for malignancy. Digital imaging technologies represent an important opportunity during the COVID-19 pandemic to share colposcopic images with reference centers, with the aim of avoiding any concentration of patients. All patients must undergo screening for COVID-19 exposure and should wear a surgical mask. A high-efficiency filter smoke evacuation system is mandatory to remove surgical smoke. Electrosurgical instruments should be set at the lowest possible power and not be used for long continuous periods to reduce the amount of surgical smoke. The following personal protective equipment should be used: sterile fluid-repellant surgical gloves, an underlying pair of gloves, eye protection, FFP3 mask, surgical cap, and gown. The colposcope should be protected by a disposable transparent cover. A protective lens that must be disinfected after each use should be applied. The use of a video colposcope should be preferred.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Colposcopia/normas , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Doenças dos Genitais Femininos/cirurgia , Controle de Infecções/normas , Pandemias , Pneumonia Viral , Adulto , Biópsia , Consenso , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/patologia , Humanos , Itália , Programas de Rastreamento , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Gravidez , Fatores de Tempo
9.
R I Med J (2013) ; 103(3): 63-67, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32236167

RESUMO

INTRODUCTION: The purpose of this review is to outline some of the major considerations when transitioning to performing total hip and knee arthroplasty in the out- patient setting. The review will discuss patient selections, peri-operative management pathways, and outcomes related to outpatient total joint arthroplasty (TJA). PATIENT SELECTION: Appropriate patient selection is key to successful outpatient TJA. Multiple indices have been proposed to estimate patient risk before undergoing outpatient TJA. Perioperative Management: In order to provide a successful outpatient TJA experience, pre-operative education class and physical therapy session can set expectations and prepare the patient for the post-operative recovery at home. Specific anesthesia techniques focus on regional blocks, multi-modal pain control, and reduction of post-operative nausea and vomiting and rapid recovery protocols have been developed to provide early mobilization and physical therapy. OUTCOMES: Nationwide analyses have found improved complication rates ranging from 1.3%-3% in outpatient TJA group compared to 3%-12% in the inpatient TJA group. Financial analyses have found significant cost savings for outpatient TJA mostly related to reduction in surgical floor care. CONCLUSION: Outpatient TJA has the potential to improve patient experience with cost savings and no increased risk of complications in the appropriately selected patient population.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Artroplastia de Substituição/tendências , Pacientes Ambulatoriais , Seleção de Pacientes , Assistência Perioperatória/métodos , Redução de Custos , Humanos , Tempo de Internação/economia , Avaliação de Resultados em Cuidados de Saúde , Estados Unidos
10.
Spine (Phila Pa 1976) ; 45(6): 397-404, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31593062

RESUMO

STUDY DESIGN: Quality improvement with before and after evaluation of the intervention. OBJECTIVE: To evaluate postoperative opioid utilization at a high-volume tertiary referral center following implementation of an opioid reduction protocol for simple outpatient neurosurgical procedures. SUMMARY OF BACKGROUND DATA: The opioid epidemic has been well-publicized both in the scientific and lay press over the last few years. As a response to this crisis many state-wide and national medical groups have sought to develop opioid prescribing guidelines for both acute and chronic pain states. Some guidelines have studied opioid prescribing in orthopedic procedures but have primarily limited their recommendations to simple outpatient orthopedic joint procedures. Although, it is not clear that these opioid prescribing reductions are directly translatable to neurosurgical procedures. METHODS: We implemented an opioid reduction protocol geared towards the postoperative management for simple outpatient neurosurgical procedures and measured the effect on number of pills and total morphine equivalent dose (MED) prescribed, postoperative readmissions, refill requests, and conversion to long-term opiate use. RESULTS: Our study population was 246 patients, with 109 patients in the pre-intervention (PRE) group and 137 patients in the post-intervention (POST) group. The vast majority of patients in both groups were discharged with an opioid prescription (93% PRE, 91% POST, P = 0.87). The POST group had significantly lower total discharge opioid medication quantity (52 tabs PRE, 27 tabs POST, P < 0.001), discharge day MED (51.3 PRE, 45.3 POST, P = 0.01), and total discharge MED (287 PRE, 149 POST, P < 0.001). CONCLUSION: A standardized discharge protocol for postoperative neurosurgery can lead to significant reductions in opioid discharge quantity without compromising patient safety or increasing the utilization of hospital resources through readmissions, refill requests, or clinic phone calls. This study provides an example of a feasible and effective discharge prescription regimen that may be generalizable to some of the most common outpatient neurosurgical procedures. LEVEL OF EVIDENCE: 3.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Analgésicos Opioides/administração & dosagem , Protocolos Clínicos/normas , Procedimentos Neurocirúrgicos/normas , Dor Pós-Operatória/tratamento farmacológico , Melhoria de Qualidade/normas , Idoso , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Analgésicos Opioides/efeitos adversos , Prescrições de Medicamentos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Dor Pós-Operatória/etiologia , Alta do Paciente/normas , Segurança do Paciente/normas
11.
J Bone Joint Surg Am ; 102(2): 110-118, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31644523

RESUMO

BACKGROUND: Increased scrutiny of health-care costs and inpatient length of stay has resulted in many orthopaedic procedures transitioning to outpatient settings. Recent studies have supported the safety and efficiency of outpatient fracture procedures. The aim of the present study was to reduce unnecessary inpatient hospitalizations for healthy patients awaiting surgical treatment of a fracture by 80% by June 30, 2017, with a focus on timely, efficient, and patient-centered care. METHODS: The study design was a time series using statistical process control methodology. Baseline data from October 2014 to June 2016 were compared with the intervention period from July 2016 to December 2018. The Model for Improvement was used as the framework for developing and implementing interventions. The main interventions were a policy change to allow booking of outpatient urgent-room cases, education for patients and nurses, and the development of a standardized outpatient pathway. RESULTS: One hundred and eighty-seven patients during the pre-intervention period and 308 patients during the intervention period were eligible for the ambulatory pathway. The percentage of patients managed as outpatients increased from 1.6% pre-intervention to 89.1% post-intervention. The length of stay was reduced from 2.8 to 0.2 days, a decrease of 94.0%. Patient satisfaction remained high, and there were no safety concerns while patients waited at home for the surgical procedure. CONCLUSIONS: The outpatient fracture pathway vastly improved the efficiency and timeliness of care and reduced health-care costs. A patient-centered culture and support from hospital administration were integral in producing sustainable improvement. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Clínicos/organização & administração , Fraturas Ósseas/cirurgia , Admissão do Paciente/normas , Procedimentos Cirúrgicos Ambulatórios/normas , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Assistência Centrada no Paciente , Melhoria de Qualidade , Tempo para o Tratamento
12.
Surgery ; 167(1): 117-123, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31582306

RESUMO

BACKGROUND: Overnight hospitalization after thyroid surgery has been a widely adopted practice because of the concern for complications such as hypocalcemia and hematoma. Same-day discharge, however, has become popular in recent years. METHODS: The American College of Surgeons National Surgical Quality Improvement Program Targeted Thyroidectomy database (2016-2017) was used to identify patients who underwent thyroid resections. A 1:1 propensity score matching was used to match patients who were discharged on postoperative day 0 and those discharged on postoperative days 1 or 2. Multivariable logistic regression models were constructed to assess the association between discharge timing and postoperative outcomes. RESULTS: Of the 10,502 patients, 2,776 (26.4%) were discharged on postoperative day 0, and 7,726 (73.6%) were discharged on postoperative days 1 or 2. After propensity score matching, 1,977 matched pairs were created. In this matched cohort, the rates of readmission were similar when comparing patients discharged on postoperative day 0 with those discharged on postoperative days 1 or 2 (odds ratio 1.26, 95% confidence interval 0.78-2.05). Likewise, no differences were observed in the rates of surgical site infection, clinically severe hypocalcemia, neck hematoma, or recurrent laryngeal nerve injury. CONCLUSION: In a national cohort of patients undergoing thyroid surgery, same-day discharge was not associated with greater rates of readmission or complications when compared with discharge 1 or 2 days after thyroid surgery.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Tempo de Internação , Alta do Paciente/normas , Complicações Pós-Operatórias/epidemiologia , Tireoidectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/normas , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Hematoma/epidemiologia , Hematoma/etiologia , Hematoma/prevenção & controle , Humanos , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pescoço , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Guias de Prática Clínica como Assunto , Fatores de Risco , Tireoidectomia/métodos , Tireoidectomia/normas
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1118-1123, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874526

RESUMO

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto/normas , Protectomia/normas , Idoso , Canal Anal/cirurgia , Humanos , Reto/cirurgia
14.
Otolaryngol Clin North Am ; 52(6): 1157-1167, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31551126

RESUMO

With today's technological advances in outpatient surgery, anesthetic technique does not differ significantly between inpatient and outpatient settings. It is important to decide which setting is most appropriate for the patient based on the surgeon's ability, the patient's comorbidities, the facility resources, and the staff who will provide care for the patient. Matching all of the above can lead to good outcomes, less complications, and a good patient experience.


Assuntos
Assistência Ambulatorial/normas , Procedimentos Cirúrgicos Ambulatórios/normas , Anestesia/normas , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Assistência Ambulatorial/métodos , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Comorbidade , Humanos , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Segurança do Paciente , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Fatores de Risco
15.
Dan Med J ; 66(9)2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31495373

RESUMO

INTRODUCTION: There has been an increased focus on fast-track (FT) programmes and the potential to convert unicompartmental knee replacement (UKR) from short-term admission to outpatient surgery. However, relatively few studies have been presented and with differences in selection criteria and completion rates. The purpose of this study was to describe patient selection and completion rates in a patient group undergoing UKR in two high-volume FT knee surgery clinics. METHODS: All consecutive patients (n = 368) referred to and selected for UKR were screened for eligibility for outpatient surgery with discharge on the day of surgery (DOS). Reasons why the patients were not discharged were recorded in patients not completing the outpatient pathway, and readmissions and complications were recorded until three months post-operatively. RESULTS: Among all referred and screened patients, 69% were considered eligible for outpatient surgery. DOS discharge occurred in 59% of the operated patients and in 37% of all referred and screened patients. Main reasons for why patients were not discharged were active wound drainage and lack of mobilisation due to pain, nausea and vomiting. Two patients were readmitted during the first 24 hours due to wound drainage. One patient had a lung embolus and one patient an acute myocardial infarction during the follow-up period. CONCLUSIONS: This study illustrates that not all patients in a consecutive patient group for UKR were feasible for outpatient surgery. Further studies should focus on optimising pain treatment and reducing post-operative nausea. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Artroplastia do Joelho/métodos , Alta do Paciente/normas , Idoso , Artroplastia do Joelho/psicologia , Artroplastia do Joelho/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
16.
Rev Col Bras Cir ; 46(3): e20192197, 2019 Jul 10.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31291434

RESUMO

This article proposes the use of a safe surgical checklist in the teaching of the discipline of Ambulatory Surgery during medical graduation. It discusses its benefits and potential implementation and adherence difficulties. It underscores the importance of developing a patient safety culture and active learning methodologies to train students for greater commitment and accountability with the quality of care provided to the community in the academic outpatient clinic of the school hospital.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Lista de Checagem/normas , Educação Médica/normas , Cuidados Pré-Operatórios/normas , Gestão da Segurança/normas , Procedimentos Cirúrgicos Ambulatórios/educação , Lista de Checagem/instrumentação , Educação Médica/métodos , Humanos , Erros Médicos/prevenção & controle , Segurança do Paciente , Cuidados Pré-Operatórios/educação , Gestão da Segurança/métodos , Materiais de Ensino
17.
Anesth Analg ; 129(2): 347-349, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31166228

RESUMO

This document represents a joint effort of the Society for Ambulatory Anesthesia (SAMBA) and the Ambulatory Surgical Care Committee of the American Society of Anesthesiologists (ASA) concerning the safe anesthetic care of adult malignant hyperthermia (MH)-susceptible patients in a free-standing ambulatory surgery center (ASC). Adult MH-susceptible patients can safely undergo a procedure in a free-standing ASC assuming that proper precautions for preventing, identifying, and managing MH are taken. The administration of preoperative prophylaxis with dantrolene is not indicated in MH-susceptible patients scheduled for elective surgery. There is no evidence to recommend an extended stay in the ASC, and the patient may be discharged when the usual discharge criteria for outpatient surgery are met. Survival from an MH crisis in an ASC setting requires early recognition, prompt treatment, and timely transfer to a center with critical care capabilities.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Anestesia/normas , Hospitalização , Hipertermia Maligna/terapia , Centros Cirúrgicos/normas , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Anestesia/efeitos adversos , Dantroleno/administração & dosagem , Diagnóstico Precoce , Humanos , Hipertermia Maligna/diagnóstico , Hipertermia Maligna/etiologia , Relaxantes Musculares Centrais/administração & dosagem , Transferência de Pacientes/normas , Medição de Risco , Fatores de Risco , Resultado do Tratamento
18.
Am Fam Physician ; 99(12): 760-766, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-31194482

RESUMO

The Bartholin glands, located in the base of the labia minora, have a role in vaginal lubrication. Because of the presence of other glands, removal of a Bartholin gland does not affect lubrication. Ductal blockage of these typically pea-sized structures can result in enlargement of the gland and subsequent development of Bartholin duct cysts or gland abscesses. Two percent of women will develop a cyst or an abscess in their lifetime, and physicians should be familiar with the range of treatment options. Bartholin duct cysts and gland abscesses can be treated in the office. The healing and recurrence rates are similar among fistulization, marsupialization, and silver nitrate and alcohol sclerotherapy. Needle aspiration and incision and drainage, the two simplest procedures, are not recommended because of the relatively increased recurrence rate.


Assuntos
Abscesso/fisiopatologia , Abscesso/cirurgia , Procedimentos Cirúrgicos Ambulatórios/normas , Glândulas Vestibulares Maiores/fisiopatologia , Glândulas Vestibulares Maiores/cirurgia , Cistos/fisiopatologia , Cistos/cirurgia , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade
19.
J Perianesth Nurs ; 34(5): 938-945, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31204275

RESUMO

PURPOSE: A presurgical pregnancy testing protocol is recommended to prevent the administration of surgery and anesthesia to women of childbearing years who present for surgery with an undetected pregnancy. It is important to determine the compliance, cost analysis, time required, and barriers to complete a presurgical pregnancy testing protocol. DESIGN: Postimplementation qualitative and quantitative evaluation of a presurgical pregnancy protocol. METHODS: A review of the patient's electronic medical record, survey of the nursing staff, and an administrative interview was conducted 1 year after implementation of the presurgical pregnancy protocol. FINDINGS: Overall presurgical pregnancy protocol compliance was 0.7%. The total labor and equipment costs were $19,033 to $30,202 per year. Nurses reported significant time- and patient-related barriers to execute the protocol. CONCLUSIONS: A pregnancy testing protocol is a valuable safety measure that faces barriers, which can impede compliance. Through the use of simplified protocols, educational interventions for patients and providers, protocol compliance can be increased.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Adulto , Procedimentos Cirúrgicos Ambulatórios/normas , Gonadotropina Coriônica/análise , Gonadotropina Coriônica/sangue , Feminino , Humanos , Pessoa de Meia-Idade , North Carolina , Gravidez , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Pesquisa Qualitativa , Inquéritos e Questionários
20.
Obstet Gynecol Clin North Am ; 46(2): 379-387, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056138

RESUMO

The past 4 decades have seen a remarkable re-engineering of health care, particularly with respect to surgical services and the formalization of patient safety protocols. As various forces drove many surgical procedures to the ambulatory setting, many advantages, and perhaps several disadvantages, quickly became apparent. In some studies, adverse events were found to be more common in office settings for instance, and it was quickly recognized that the formal quality controls that had evolved in the hospital setting were not always transferred to the outpatient facility. This article traces the development of health care's response to this challenge.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Procedimentos Cirúrgicos em Ginecologia/métodos , Segurança do Paciente , Acreditação , Assistência Ambulatorial , Procedimentos Cirúrgicos Ambulatórios/mortalidade , Procedimentos Cirúrgicos Ambulatórios/normas , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Feminino , Procedimentos Cirúrgicos em Ginecologia/mortalidade , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Erros Médicos/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Fatores de Risco , Resultado do Tratamento
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