A real-world study of an ambulatory management model for vitrectomy surgery_Chinese Journal of Ocular Fundus Diseases

Authors：

Wang Manqiao , Liu Boshi , Hu Bojie , Cheng Zhaohui , Han Jindong , Liu Juping , Zhang Longli , Shao Yan , Shi Yi , Ren Xinjun , Zhang Nan ,  Li Xiaorong

Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Centerfor Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China;

Corresponding author：

Li Xiaorong, Email: xiaorli@163.com

Keywords：

Ambulatory surgery; Pars plana vitrectomy; Hospital management; Real-world study

DOI：

10.3760/cma.j.cn511434-20240117-00032

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Objective To evaluate changes in operational effectiveness after the implementation of ambulatory surgical management in pars plana vitrectomy (PPV). Methods A retrospective clinical study. 17 528 surgeries in 10 895 eyes of 10 895 patients who underwent minimally invasive PPV on an ambulatory and/or inpatient basis at Tianjin Medical University Eye Hospital from August 2015 to June 2023 were included in this study. Among them, 5 346 eyes in 5 346 cases were male; 5 549 eyes in 5 549 cases were female. The age ranged from 0 to 95 years, with the mean age of (57.74±13.15) years. 6 381 surgeries in 3 615 eyes from August 2015 to December 2018 (the initial period of day surgery) were used as the control group; 11 147 surgeries in 7 280 eyes from January 2019 to June 2023 (the expanded period of day surgery) were used as the observation group. According to the management mode of ambulatory surgery, the observation group was subdivided into the decentralized management group (January 2019 to December 2020) and the centralized management group (January 2021 to June 2023), with 2 905 and 4 375 eyes and 4 646 and 6 501 surgeries, respectively. Changes in the percentage of day surgery, average hospitalization days, and average unplanned reoperation rate were compared. The Mann-Whitney U test was used to compare numerical variables between groups; the chi-square test or Fisher's exact test was used to compare categorical variables. Results The number of cases of daytime PPV performed in the observation group and control group was 7 852 (70.44%, 7 852/11 147) and 24 (0.38%, 24/6 381) cases, respectively, and the average hospitalization days were 1 (1) and 5 (3) d. Compared with the control group, the observation group had a significantly higher percentage of day surgery (χ²=8 051.01) and a considerably lower mean hospitalization day (Z=4 536 844.50), and the differences were statistically significant (P＜0.000 1). The mean hospitalization days in the decentralized and centralized management groups were 2 (3) and 1 (0) d, respectively, and unplanned reoperations were 34 (0.73%, 34/4 646) and 171 (2.63%, 171/6 501) eyes, respectively. Compared with the decentralized management group, average hospitalization days was significantly lower (Z=1 436.94) and unplanned reoperation rate was significantly higher (χ²=54.10) were significantly lower in the centralized management group, both of which were statistically significant (P＜0.000 1). Conclusion PPV ambulatory management model can significantly reduce the average hospitalization day, but also results in higher rates of unplanned reoperations.

Citation： Wang Manqiao, Liu Boshi, Hu Bojie, Cheng Zhaohui, Han Jindong, Liu Juping, Zhang Longli, Shao Yan, Shi Yi, Ren Xinjun, Zhang Nan, Li Xiaorong. A real-world study of an ambulatory management model for vitrectomy surgery. Chinese Journal of Ocular Fundus Diseases, 2024, 40(8): 614-618. doi: 10.3760/cma.j.cn511434-20240117-00032 Copy

1.	Gwinnutt C. Day surgery[J]. Practitioner, 1991, 235(1507): 738-742.
2.	Jarrett PE. Day surgery--the future[J]. Ann Chir Gynaecol, 1995, 84(4): 379-383.
3.	Bailey CR, Ahuja M, Bartholomew K, et al. Guidelines for day-case surgery 2019: guidelines from the Association of Anaesthetists and the British Association of Day Surgery[J]. Anaesthesia, 2019, 74(6): 778-792. DOI: 10.1111/anae.14639.
4.	潘锋. 创新服务模式日间手术促进公立医院高质量发展[J]. 中国当代医药, 2023, 30(31): 1-4. DOI: 10.3969/j.issn.1674-4721.2023.31.002.Pan F. Innovative service model of ambulatory surgery to promote high-quality development of public hospitals[J]. China Modern Medicine, 2023, 30(31): 1-4. DOI: 10.3969/j.issn.1674-4721.2023.31.002.
5.	夏鑫, 郭趣, 卢爽, 等. 我国日间手术研究现状与分析[J]. 全科护理, 2023, 21(18): 2482-2485. DOI: 10.12104/j.issn.1674-4748.2023.18.008.Xia X, Guo Q, Lu S, et al. Research status quo and analysis of ambulatory surgery in China[J]. Chinese General Practice Nursing, 2023, 21(18): 2482-2485. DOI: 10.12104/j.issn.1674-4748.2023.18.008.
6.	任新军, 郑传珍, 李筱荣. 微创玻璃体切除术临床应用进展[J]. 天津医科大学学报, 2019, 25(4): 426-429.Ren XJ, Zheng CZ, Li XR. Progress in clinical application of minimally invasive vitrectomy[J]. Journal of Tianjin Medical University, 2019, 25(4): 426-429.
7.	Pollack JS, Sabherwal N. Small gauge vitrectomy: operative techniques[J]. Curr Opin Ophthalmol, 2019, 30(3): 159-164. DOI: 10.1097/ICU.0000000000000568.
8.	Hilton GF, Josephberg RG, Halperin LS, et al. Office-based sutureless transconjunctival pars plana vitrectomy[J]. Retina, 2002, 22(6): 725-732. DOI: 10.1097/00006982-200212000-00007.
9.	陈聪, 蔡俊杰, 金约西, 等. 白内障日间和住院手术连台流程优化的效果评价[J]. 温州医科大学学报, 2020, 50(3): 254-256. DOI: 10.3969/j.issn.2095-9400.2020.03.018.Chen C, Cai JJ, Jin YX, et al. Evaluation of the optimized consecutive operation process for day-care and in-patient cataract surgery[J]. Journal of Wenzhou Medical University, 2020, 50(3): 254-256. DOI: 10.3969/j.issn.2095-9400.2020.03.018.
10.	王冠一, 刘淑贤, 倪如暘. 白内障日间手术流程优化效果评价[J]. 华西医学, 2023, 38(2): 185-189. DOI: 10.7507/1002-0179.202211198.Wang GY, Liu SX, Ni RY, Effectiveness evalution of process optimization of cataract ambulatory surgery[J]. West China Medical Journal, 2023, 38(2): 185-189. DOI: 10.7507/1002-0179.202211198.
11.	黄世欣, 刘健, 王宏宇, 等. 白内障日间手术医院感染预防相关研究进展[J]. 中国中医眼科杂志, 2022, 32(10): 834-836. DOI: 10.13444/j.cnki.zgzyykzz.2022.10.019.Huang SX, Liu J, Wang HY, et al. Research progress on prevention of hospital infection in cataract ambulatory surgery[J]. China Journal of Chinese Ophthalmology, 2022, 32(10): 834-836. DOI: 10.13444/j.cnki.zgzyykzz.2022.10.019.
12.	Hussain R, Matare T, Zambarakji H. National survey of day-case vitreoretinal surgery in the United Kingdom[J]. Eur J Ophthalmol, 2011, 21(2): 183-188. DOI: 10.5301/ejo.2010.1441.
13.	Rajan N, Rosero EB, Joshi GP. Patient selection for adult ambulatory surgery: a narrative review[J]. Anesth Analg, 2021, 133(6): 1415-1430. DOI: 10.1213/ane.0000000000005605.
14.	Diekmann PR, O'Neill OR, Floyd ER, et al. Orthopedic surgery in ambulatory surgery centers during the COVID-19 pandemic: low incidence of infection among patients, surgeons, and staff[J/OL]. Cureus, 2022, 14(4): e24247[2022-04-18]. https://pubmed.ncbi.nlm.nih.gov/35602796/. DOI: 10.7759/cureus.24247.
15.	门宇, 刘淑贤, 倪如暘, 等. 新型冠状病毒肺炎疫情防控常态化下眼科日间手术中心的安全与质量管理[J]. 华西医学, 2021, 36(2): 156-159. DOI: 10.7507/1002-0179.202011287.Men Y, Liu SX, Ni RY, et al. Safety and quality management of ophthalmic day surgery center under the regular prevention and control for coronavirus disease 2019 epidemic[J]. West China Medical Journal, 2021, 36(2): 156-159. DOI: 10.7507/1002-0179.202011287.

1. Gwinnutt C. Day surgery[J]. Practitioner, 1991, 235(1507): 738-742.
2. Jarrett PE. Day surgery--the future[J]. Ann Chir Gynaecol, 1995, 84(4): 379-383.
3. Bailey CR, Ahuja M, Bartholomew K, et al. Guidelines for day-case surgery 2019: guidelines from the Association of Anaesthetists and the British Association of Day Surgery[J]. Anaesthesia, 2019, 74(6): 778-792. DOI: 10.1111/anae.14639.
4. 潘锋. 创新服务模式日间手术促进公立医院高质量发展[J]. 中国当代医药, 2023, 30(31): 1-4. DOI: 10.3969/j.issn.1674-4721.2023.31.002.Pan F. Innovative service model of ambulatory surgery to promote high-quality development of public hospitals[J]. China Modern Medicine, 2023, 30(31): 1-4. DOI: 10.3969/j.issn.1674-4721.2023.31.002.
5. 夏鑫, 郭趣, 卢爽, 等. 我国日间手术研究现状与分析[J]. 全科护理, 2023, 21(18): 2482-2485. DOI: 10.12104/j.issn.1674-4748.2023.18.008.Xia X, Guo Q, Lu S, et al. Research status quo and analysis of ambulatory surgery in China[J]. Chinese General Practice Nursing, 2023, 21(18): 2482-2485. DOI: 10.12104/j.issn.1674-4748.2023.18.008.
6. 任新军, 郑传珍, 李筱荣. 微创玻璃体切除术临床应用进展[J]. 天津医科大学学报, 2019, 25(4): 426-429.Ren XJ, Zheng CZ, Li XR. Progress in clinical application of minimally invasive vitrectomy[J]. Journal of Tianjin Medical University, 2019, 25(4): 426-429.
7. Pollack JS, Sabherwal N. Small gauge vitrectomy: operative techniques[J]. Curr Opin Ophthalmol, 2019, 30(3): 159-164. DOI: 10.1097/ICU.0000000000000568.
8. Hilton GF, Josephberg RG, Halperin LS, et al. Office-based sutureless transconjunctival pars plana vitrectomy[J]. Retina, 2002, 22(6): 725-732. DOI: 10.1097/00006982-200212000-00007.
9. 陈聪, 蔡俊杰, 金约西, 等. 白内障日间和住院手术连台流程优化的效果评价[J]. 温州医科大学学报, 2020, 50(3): 254-256. DOI: 10.3969/j.issn.2095-9400.2020.03.018.Chen C, Cai JJ, Jin YX, et al. Evaluation of the optimized consecutive operation process for day-care and in-patient cataract surgery[J]. Journal of Wenzhou Medical University, 2020, 50(3): 254-256. DOI: 10.3969/j.issn.2095-9400.2020.03.018.
10. 王冠一, 刘淑贤, 倪如暘. 白内障日间手术流程优化效果评价[J]. 华西医学, 2023, 38(2): 185-189. DOI: 10.7507/1002-0179.202211198.Wang GY, Liu SX, Ni RY, Effectiveness evalution of process optimization of cataract ambulatory surgery[J]. West China Medical Journal, 2023, 38(2): 185-189. DOI: 10.7507/1002-0179.202211198.
11. 黄世欣, 刘健, 王宏宇, 等. 白内障日间手术医院感染预防相关研究进展[J]. 中国中医眼科杂志, 2022, 32(10): 834-836. DOI: 10.13444/j.cnki.zgzyykzz.2022.10.019.Huang SX, Liu J, Wang HY, et al. Research progress on prevention of hospital infection in cataract ambulatory surgery[J]. China Journal of Chinese Ophthalmology, 2022, 32(10): 834-836. DOI: 10.13444/j.cnki.zgzyykzz.2022.10.019.
12. Hussain R, Matare T, Zambarakji H. National survey of day-case vitreoretinal surgery in the United Kingdom[J]. Eur J Ophthalmol, 2011, 21(2): 183-188. DOI: 10.5301/ejo.2010.1441.
13. Rajan N, Rosero EB, Joshi GP. Patient selection for adult ambulatory surgery: a narrative review[J]. Anesth Analg, 2021, 133(6): 1415-1430. DOI: 10.1213/ane.0000000000005605.
14. Diekmann PR, O'Neill OR, Floyd ER, et al. Orthopedic surgery in ambulatory surgery centers during the COVID-19 pandemic: low incidence of infection among patients, surgeons, and staff[J/OL]. Cureus, 2022, 14(4): e24247[2022-04-18]. https://pubmed.ncbi.nlm.nih.gov/35602796/. DOI: 10.7759/cureus.24247.
15. 门宇, 刘淑贤, 倪如暘, 等. 新型冠状病毒肺炎疫情防控常态化下眼科日间手术中心的安全与质量管理[J]. 华西医学, 2021, 36(2): 156-159. DOI: 10.7507/1002-0179.202011287.Men Y, Liu SX, Ni RY, et al. Safety and quality management of ophthalmic day surgery center under the regular prevention and control for coronavirus disease 2019 epidemic[J]. West China Medical Journal, 2021, 36(2): 156-159. DOI: 10.7507/1002-0179.202011287.

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A real-world study of an ambulatory management model for vitrectomy surgery

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