ObjectiveTo investigate the value of single incision laparoscopic cholecystectomy in the operation of benign diseases of the gallbladder in day surgery.MethodThe clinical data of 105 patients underwent the single incision laparoscopic cholecystectomy in the Day Operation Center of Zhengzhou Central Hospital of Zhengzhou University from March 2017 to December 2018 were retrospectively analyzed.ResultsThe single incision laparoscopic cholecystectomies were successfully performed in 105 patients with benign gallbladder diseases, including 65 cases of gallbladder stones, 26 cases of gallbladder polyps, 14 cases of gallbladder adenomyosis; 45 cases of men and 60 cases of women. In all cases, no incision was increased or no case was converted to laparotomy. No bile duct injury and intra-abdominal bleeding happened during the operation. All patients were discharged overnight (no more than 24 h) after the surgery and without delayed discharge and re-admission. The intraoperative blood loss was (10.3±3.5) mL, and the operation time was (55.0±25.5) min (from laparoscopy to gallbladder removal). The postoperative pain score was 1–2 and 0–1 on day 1 and on day 3 after the surgery, respectively. The postoperative incision cosmetic satisfaction score on month 6 after the operation was 4.5±0.5.ConclusionSingle incision laparoscopic cholecystectomy is safe and feasible for benign gallbladder disease during day surgery.
ObjectiveTo compare the intraoperative, postoperative indicators and economic costs of varicose veins patients between day surgery and inpatient surgery, and to explore the safety and benefit of large-scale varicose veins day surgery in China.MethodsA retrospective study was conducted to collect varicose veins patients in West China Hospital of Sichuan University from January 2016 to January 2019. Patients were divided into the day surgery group and the inpatient surgery group, and the subjects were matched by the propensity score matching (PSM) method according to the basic characteristic data. Intraoperative and postoperative indicators and economic costs were compared between the two groups.ResultsA total of 1 806 varicose vein patients were enrolled in the study, and 502 patients were enrolled in each of the two groups after PSM matching. After matching, there were no statistically significant differences in gender, age, nationality, marriage status, working status, residence, number of operative legs, medical insurance type, grade of American Society of Anesthesiologists, and complications (including hypertension, diabetes, coronary heart disease, and respiratory system diseases) between the two groups (P>0.05), which were comparable and the differences were not statistically significant. Compared with the inpatient surgery group, the day surgery group had shorter hospital stay, less intraoperative infusion volume, lower total cost, bed cost, nursing cost, drug cost, examination cost, medical insurance, and out-of-pocket (P<0.05). ConclusionThe varicose veins day surgery is not only safe and effective, but also can reduce the medication insurance payment.
ObjectiveTo explore the application of clinical pathway in patients undergoing orthopedic day surgery.MethodsPatients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group, and all of them were managed by clinical pathway. Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group, and all of them were managed by conventional clinical methods. The general conditions of patients, physicians’ work efficiency, medical costs and medical quality were compared between the two groups.ResultsThe clinical pathway group included 246 patients, and the routine group included 391 patients. There was no significant difference in gender, age or disease distribution between the two groups (P>0.05). Compared with the routine group, the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time [(5.64±3.29) vs. (2.12±1.05) min], average number of revisions per physician’s order (1.40±0.24 vs. 0.38±0.19), rate of filing medical records within 3 days (90.28% vs. 97.97%), hospital costs [(7462.10±1035.01) vs. (6252.52±1189.05) yuan], drug costs [(652.21±88.53) vs. (437.17±108.20) yuan], length of stay [(1.23±1.04) vs. (1.02±0.18) d] and delayed discharge rate (7.93% vs. 2.03%), with statistically significant differences (P<0.05). There was no significant difference between the two groups in terms of unplanned reoperation rate, unplanned rehospitalization rate, or patient satisfaction (P>0.05).ConclusionCompared with routine clinical management, clinical pathway management can improve work efficiency, reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery, which has very positive effects and is worthy of promotion and application.
Objective To understand the incidence and severity of postoperative acute pain in patients undergoing day surgery, and to explore the influencing factors of moderate to severe pain after surgery, so as to provide a reference for pain management in day surgery. Methods Convenience sampling method was used to select patients undergoing day surgery under multi-modal pain management in West China Hospital of Sichuan University between April and August 2020, and the general conditions, surgical conditions, and postoperative pain of the patients were investigated. According to the degree of postoperative pain, patients were divided into mild pain group and moderate to severe pain group. Logistic regression analysis was used to explore the influencing factors of postoperative pain in the two groups. Results A total of 509 patients were finally included, of which 69 patients presented with moderate to severe pain. Logistic regression analysis showed that patient age [odds ratio (OR)=0.970, 95% confidence interval (CI) (0.946, 0.993), P=0.012], pain threshold [OR=1.348, 95%CI (1.048, 1.734), P=0.020] and postoperative drainage tube [OR=2.752, 95%CI (1.090, 6.938), P=0.017] were the influencing factors of moderate to severe pain after surgery. Conclusion Under multimodal pain management, the incidence of moderate to severe pain in day surgery patients is low, and medical staff should further strengthen pain management from the factors affecting pain to reduce the incidence of moderate to severe pain after surgery.
After nearly 30 years of localized development of day surgery in China, in order to enable more patients to enjoy high-quality and affordable day surgery medical services, some medical institutions have begun to try same-day surgery, which means the patient can be operated and discharged within the same workday. With the help of the national three-level diagnosis and treatment service model, it provides continuous medical services and guarantees for day surgery patients through the integration of “hospital-community”. This article first introduces the development history of day surgery, summarizes the definitions and requirements of day surgery in different countries or academic associations, and finally focuses on same-day surgery in China, aims to provide some ideas for the future development of day surgery in China.
The strategies of individualized enhanced recovery after surgery (ERAS) are particularly important in the anesthesia management of same-day surgery. This review focuses on the perioperative management of day surgeries following the experiences of Day Surgery Center, West China Hospital, Sichuan University and different surgeries’ guidelines of ERAS, including anesthesia evaluation, preoperative education and optimization, comorbidity management, airway management, choice of technologies and drugs during anesthesia, intraoperative monitor and anesthesia management, postoperative analgesia, postoperative nausea and vomiting prevention, and postoperative management, which is significant to ensure the discharge of the patient in time for same-day surgeries.
Objective To investigate the efficacy and safety of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia. Methods This study used a prospective randomized controlled study approach. A total of 60 day surgery patients requiring hysteroscopic surgery under general anesthesia admitted to Weifang People’s Hospital between October and December 2020 were randomly selected. All patients were divided into trial group and control group by completely random number table method, with 30 patients in each group. The trial group received paracervical block combined with total intravenous anesthesia with alfentanil, and the control group received total intravenous anesthesia with alfentanil. The general condition, operation time, recovery time, intraoperative propofol dosage, postoperative pain score, intraoperative motion response and postoperative nausea and vomiting incidence were compared between the two groups. Results There was no significant difference in age, body mass index and incidence of comorbidities between the two groups (P>0.05). There was no significant difference in the operation time, recovery time, pain score at 2 hours after operation, and incidence of nausea and vomiting between the two groups (P>0.05). In the control group, the dose of propofol [(34.07±12.67) vs. (28.33±9.10) mL], the pain score on awakening (1.50±0.78 vs. 0.77±0.50), and the incidence of body movement response (20.0 % vs. 0.0%) were higher than the trial group (P<0.05). Conclusion The use of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia can reduce the amount of propofol during the operation, reduce postoperative pain, and reduce perioperative adverse reactions, which has a good efficacy and safety.
Under the same-day surgery mode, anesthesiologists play an important role in ensuring patient safety, eliminating medical risks, practicing the concept of enhanced recovery after surgery, and realizing comfortable diagnosis and treatment, and a standardized anesthesia management process is the key to protect patients. Based on the principled suggestions in The Consensus of Chinese Experts on Anaesthesia for Day Surgery, combined with the advanced management experience of day surgery anesthesia at home and abroad, and repeatedly revised through practice, a comprehensive, rigorous, and standardized anesthesia management process for same-day surgery was gradually explored by the First Affiliated Hospital of Dalian Medical University. This paper introduces the process from the aspects of procedure of anesthesia evaluation in same-day surgery, preoperative preparation, standardized intraoperative anesthesia management, postoperative pain management, and prevention and treatment of postoperative complications.
Objective To analyze the influencing factors of single-center day surgery patients who are discharged from the hospital on the same-day, in order to provide reference and basis for the clinical practice of follow-up day surgery. Methods The electronic medical records of patients who underwent day surgery in the Day Surgery Center of the First Affiliated Hospital of the Air Force Military Medical University between February and October 2021 were analyzed retrospectively. The patients were divided into the same-day discharge group and non-same-day discharge group. The baseline data and perioperative indicators of the patients were analyzed. Results A total of 857 patients were included, including 264 patients (30.81%) in the same-day discharge group and 593 patients (69.19%) in the non-same-day discharge group. Univariate analysis showed that there were significant differences between the two groups in gender, age, body mass index, whether the first one, disease classification, anesthesia method, and intraoperative blood loss (P<0.05). Logistic regression analysis showed that gender, whether the first one, disease classification, surgical grade, anesthesia method, and intraoperative blood loss were independent factors affecting the delayed discharge of patients undergoing daytime surgery (P<0.05). Conclusions There are many factors that affect day surgery patients’ discharge. It is suggested that more rigorously screen patients for day surgery, improve medical technology, strengthen out-of-hospital continued care, and optimize management procedures, so as to shorten the time of patients in hospital and provide more information for patients, and provide more efficient and convenient medical services for patients.
Objective To investigate the safety and effect of same-day discharge in injection sclerotherapy for children with hemangioma (IJCH) and tension-free hernioplasty for adults with inguinal herinia (TFHA). Methods A retrospective analysis was conducted on patients undergoing IJCH or TFHA in the Day Surgery Center of West China Hospital of Sichuan University between November 2020 and October 2021. According to the patient’s condition and willingness, they were divided into same-day discharge group (162 children and 180 adults) and overnight hospitalization group (68 children and 271 adults). The amount of intraoperative bleeding, length of hospital stay, hospitalization expenses, pain before discharge, and short-term postoperative complications were compared between the two groups. Visual analogue scale was used for pain assessment in adults and children over 6 years old, and smiley face score was used in children below 6 years old. Results Compared with those in the overnight discharge group, the amount of intraoperative bleeding in the same-day discharge group was less [IJCH: (0.45±0.05) vs. (2.76±1.21) mL, P<0.05; TFHA: (1.20±0.05) vs. (6.76±2.30) mL, P<0.05], length of hospital stay was shorter [IJCH: (7.99±1.22) vs. (23.10±1.42) h, P<0.05; TFHA: (6.13±1.79) vs. (22.75±1.80) h, P<0.05], hospitalization cost was lower [IJCH: (5094.00±1320.14) vs. (6263.52±1220.20) yuan, P<0.05; TFHA: (7199.21±1535.84) vs. (7976.82±1967.82) yuan, P<0.05], pain before discharge was milder (IJCH: 0.05±0.02 vs. 0.50±0.01, P<0.05; TFHA: 1.20±0.01 vs. 2.01±0.20, P<0.05). There was no significant difference in the incidence of postoperative complications or unplanned revisit within 30 days between the two modes (P>0.05). Conclusions The same-day surgery mode is safe and feasible in IJCH and TFHA, and can shorten the length of hospital stay and reduce the cost of hospitalization. It is suggested to popularize this mode in clinical practice.