Ambulatory surgery to cope with long patient waiting lists (original) (raw)
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FEASIBILITY OF AMBULATORY SURGERY: OUR EXPERIENCE
IJCIRAS, 2020
Introduction: Ambulatory surgery is a form of surgical management. The patient stays in the hospital for the strict minimum of time. He will arrive in the morning, and must be back at home in the same day in evening. This practice is generalized now. It became possible by the progress of laparoscopy and anesthesia. Multimodal taking care of pain and nausea vomiting earlier manage the postoperative risks. The Patients are rehabilitated by advancement of knowledge. Ambulatory surgery has demonstrated its benefits for the patient in terms of quality, safety, less exposure of nosocomial infections, the thromboembolic risk and less cost. Goal of the study: Demonstrate the feasibility and reproducibility of laparoscopic cholecystectomy, proctologic surgery and inguinal hernia treatment on an outpatient basis under optimal safety conditions, also to guarantee results that approach those of the literature and to determine the causes of failure of the ambulatory procedure. Materials and methods: Descriptive study, observational, prospective and mono-centric study conducted in the CHU Oran from 04/2016 to 05/2018. With the ambulatory method, patients were admitted for surgical treatment. In order to describe the organizational aspects and risk factors for failure of the ambulatory management to judge the feasibility of this method. All patient characteristics, description of the surgical procedure, type of anesthesia, ambulatory rate, hospitalization, admissions, readmissions and unscheduled consultations are described. The level of satisfaction and intensity of postoperative complain were collected. Results: Our series included 240 patients. The average age was 43 years with extremes ranging from (18-80). There is a slight female predominance 57.9%. The sexratio was 1.37. The majority of patients were ASAI. We performed spinal anesthesia for proctological surgery and hernia cure. The average operating time was 44.87 min. The rates of intraoperative and postoperative complications were 7.08%. The causes of failure were surgical and medical. The medical complications: drowsiness type, headache, pain alone or associated with vomiting, acute retention of urine and organizational causes such as late exit from the block and (stress). The procedure failure rate was (5.8%); readmission rate was (0.41%). The rate of unscheduled consultations was (3.3%). The patient satisfaction rate was 95%. Conclusion: Our study supports the feasibility of ambulatory surgery under optimal safety conditions. It is part of an approach to improve care. It shows a low morbidity rate, good tolerance of postoperative follow-up. That was possible after a good selection of patients, by adopting anesthesia to the patient and to the intervention, by optimizing the taking in charge perioperative, which is specific by risk management within an organized structure. These conclusions encourage us to propose the establishment of an ambulatory surgery unit
The limits of ambulatory surgery
Ambulatory Surgery, 1998
The objectives of this study were to analyse the results of an ambulatory surgery unit and the influence of short stay hospitalisation (24 h) on its activity. Between May 1992 and January 1998, 12412 patients have been treated. The most active speciality was general surgery, with 5567 interventions: 3.756 were performed on an ambulatory basis, and 1811 with 24 h hospitalisation. The global substitution index for this speciality was 54.7% (78.7% if we include the patients admitted overnight). 24 h Hospitalisation favours an increment of the substitution indices by allowing more flexibility in the selection criteria and more complex cases to be treated.
BMC Health Services Research, 2010
Background: The increasing demand on hospitalisation, either due to elective activity from the waiting lists or due to emergency admissions coming from the Emergency Department (ED), requires looking for strategies that lead to effective bed management. The aim of this study was to evaluate the effectiveness of a surgery admission unit for major elective surgery patients who were admitted for same-day surgery. Methods: We included all patients admitted for elective surgery in a university tertiary hospital between the 1st of September and the 31st of December 2006, as well as those admitted during the same period of 2008, after the introduction of the Surgery Admission Unit. The main outcome parameters were global length of stay, pre-surgery length of stay, proportion of patients admitted the same day of the surgery and number of cancellations. Differences between the two periods were evaluated by the T-test and Chi-square test. Significance at P < 0.05 was assumed throughout. Results: We included 6,053 patients, 3,003 during 2006 and 3,050 patients during 2008. Global length of stay was 6.2 days (IC 95%:6.4-6) in 2006 and 5.5 days (IC 95%:5.8-5.2) in 2008 (p < 0.005). Pre-surgery length of stay was reduced from 0.46 days (IC 95%:0.44-0.48) in 2006 to 0.29 days (IC 95%:0.27-0.31) in 2008 (p < 0.005). The proportion of patients admitted for same-day surgery was 67% (IC 95%:69%-65%) in 2006 and 76% (IC 95%:78%-74%) in 2008 (p < 0.005). The number of cancelled interventions due to insufficient preparation was 31 patients in 2006 and 7 patients in 2008.
Ambulatory Surgery in Hassan II University Hospital in Fes, Morocco
2020
Introduction: Reducing hospital stays lengths and adoptions of outpatient surgery are the results of a policy of controlled hospital costs, improving quality of care and greater patient comfort. Materials and Methods: We conducted a retrospective study of the files of the patients operated at surgery department of Hassan II university hospital of Fes. This study concerned patients having hernial, gallbladder stone and proctologic pathologies (Hemorroids, Anal Fistula, Anal Fissure and Pilonidal Sinus) over 6 years from June 2009 to June 2015. Discussion: Over 6 years, 4342 patients were operated at the central operating unit, 1073 among them were ambulatory cases. The hospital stay of the gallbladder stone, hernia and proctological surgery is respectively 7.3, 5.1 and 1 day, wish remains far from figures marked in Western countries where these pathologies were practiced in ambulatory in more than 60% of the cases. This difference is explained by the lack of real health economics pol...
Hospital admission following ambulatory surgery
Amer J Surg, 1996
Ambulatory surgery continues to grow in quantity and complexity of procedures. Effective measures of "quality" are not readily apparent. "Unplanned admission rate" may well reflect the quality of care in this area. Identifying factors related to this event could be helpful in quality assessment and improvement.
Hernia in Ambulatory Surgery Centre
Hernia, 2017
Surgical treatment of hernia is one of the most common procedures in general population. Since it was traditionally treated as "non-complex" operation, it is an ideal procedure for ambulatory surgery settings. Ambulatory surgery is superior to in-hospital treatment due to faster patient flow, reduced patient stress, early mobilization, and lower overall costs. Unforeseen hospitalization can be avoided with meticulous patient selection, education and preparation, use of local anesthesia whenever possible, and avoidance of opioids in early postoperative period.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2013
Purpose The primary objectives of this historical casecontrol study were to evaluate the incidence of and reasons and risk factors for adult unanticipated admissions in three tertiary care Canadian hospitals following ambulatory surgery. Methods A random sample of 200 patients requiring admission (cases) and 200 patients not requiring admission (controls) was taken from 20,657 ambulatory procedures was identified and compared. The following variables were included: demographics, reason for admission, type of anesthesia, surgical procedure, length of procedure, American Society of Anesthesiologists' (ASA) classification, surgical completion time, pre-anesthesia clinic, medical history, medications (classes), and perioperative complications. Multiple logistic regression analysis was used to assess factors associated with unanticipated admissions.
World Journal of Emergency Surgery, 2014
Introduction: In January 2012 an acute care surgery (ACS) model was introduced at St. Paul's Hospital, Saskatoon, Saskatchewan. The goal of implementing an ACS service was to improve the delivery of care for emergent, non-trauma surgical patients. We examined whether the ACS model improved wait time to surgery, decreased the proportion of surgeries performed after hours, and shortened post-surgical length of stay. We also assessed whether the surgeons working in an ACS system had higher on-call satisfaction than surgeons working in a non-ACS system. Methods: A retrospective pre-post analysis was performed using data from the Discharge Abstract Database and the Organizing Medical Networked Information database. Surgeon satisfaction was evaluated using a questionnaire that was mailed to all general surgeons in Saskatoon. Results: An ACS service significantly reduced wait time to surgery for patients with all acute general surgery diagnoses from 221 minutes to 192 minutes (ρ = 0.015; CI = 5.8-52.2). Post-surgery length of stay for patients operated on for acute appendicitis, or acute cholecystitis was not reduced. On average, patients with bowel obstruction had increased length of stay following ACS service implementation. Most surgeries in our study were performed between 16:00 hours and 08:00 hours but the introduction of an ACS significantly reduced the number of afterhours surgeries (60.0% vs. 72.6%) (ρ < 0.0001). Our survey had a response rate of 75%. Overall, surgeons on an ACS service had greater satisfaction with the organization of their call schedule than surgeons not on an ACS service. Conclusion: Introduction of an ACS service in Saskatoon has decreased wait time to surgery and reduced the proportion of afterhours emergency surgeries, with no reduction in the length of post-surgery hospital stay. Satisfaction may be higher for surgeons in an ACS service.