Cost-effective utilization of a private facility to perform outpatient surgery in public hospital waiting list patients.

Background: Public hospitals' long waiting lists make outpatient surgery in private facilities very attractive provided a standardized protocol is applied. The aim of this study was to assess this kind of innovative collaboration in abdominal surgery from a clinical and economical perspective. Methods: All consecutive patients operated on in an outpatient basis in a private facility by a public hospital abdominal surgeon and an assistant over a 5-year period (2004-2009) were included. Clinical assessment was carried out from patients' charts and satisfaction questionnaire, and economic assessment from the comparison between the surgeons' charges paid by the private facility and the surgeons' hospital salaries during the days devoted to surgery at the private facility. Results: Over the 5 years, 602 operative procedures were carried out during 190 operative days. All patients could be discharged the same day and only 1% of minor complications occurred. The patients' satisfaction was 98%. The balance between the surgeons' charges paid by the private facility and their hospital salary costs was positive by 25.8% for the senior surgeon and 12.6% for the assistant or, on average, 21.9% for both. Conclusion: Collaboration between an overloaded university hospital surgery department and a private surgical facility was successful, effective, safe, and cost-effective. It could be extended to other surgical specialities. Copyright (C) 2011 S. Karger AG, Basel

Basic skills for outpatient surgery in medical graduation

Medical students must have domain of basic surgery skills before starting more advanced stages of surgical learning. The authors present a practical and reproducible system of operative techniques circuit, idealized and often applied to the fourth year medical students of a private educational institution. This method has enabled accurate assessment of students' skills, improving their performance and preparing them for more advanced stages of the surgical learning.

Aplicação de princípios e ferramentas lean numa unidade de cirurgia de ambulatório de um hospital

Dissertação de mestrado integrado em Engenharia Industrial

Actividad en Hospital de Día Quirúrgico en los Hospitales del SSPA. Año 2010

This report has used the MDS to meet the sigueintes questions: How do they compare ambulatory surgery and inpatient surgery?. Who is involved with outpatient surgery?. What are the most common outpatient major interventions?. How is distributed outpatient surgery by age and sex?

Lesiones laríngeas post-intubación en adultos y su relación con el tiempo de intubación: Estudio de nasofibrolaringoscopia diagnóstica

Objetivo: Determinar las lesiones laríngeas post-intubación endotraqueal en la unidad de cuidado intensivo (UCI) y cirugía ambulatoria y evaluar su asociación con respecto al tiempo de intubación y otras variables clínico-demográficas en un hospital universitario. Materiales y métodos: Estudio de cohorte analítico incluyendo 60 pacientes (30 de UCI y 30 de cirugía ambulatoria) a quienes se les realizó nasofibrolaringoscopia a las 24 horas post-extubación y a las 3 semanas de control y se registran las lesiones laríngeas encontradas. Resultados: En la primera endoscopia el 70% de los pacientes de cirugía ambulatoria presentaban al menos una lesión laríngea con un promedio de duración de intubación de 0.12 días DS±0.05 desapareciendo todas las lesiones en la segunda endoscopia. En el análisis del grupo de UCI se encontraron lesiones en el 76.6% de los pacientes con un promedio de duración de intubación de 6.0 días DS±3.3. La presencia de edema en pacientes con intubación prolongada por más de 6 días mostró diferencias estadísticamente significativa con respecto al grupo con menos días de intubación (RR 3.048, 95% IC 0.9-9.3, P=0.03) al igual que con antecedente de EPOC (P=0.032) y APACHE II mayor de 17 (RR 1.8, 95% IC 1.114-3.0, P=0.013). EPOC tiene una diferencia estadísticamente significativa con hiperemia (P=0.02) y granuloma (P=0.019). En la segunda endoscopia se encontró mayor frecuencia de hiperemia en los pacientes con intubación prolongada (>6 días) con una diferencia estadísticamente significativa (P=0.01). Conclusión: La intubación prolongada se encuentra asociada a la aparición edema e hiperemia en la laringe. EPOC y puntaje superior de APACHE II se relacionan con hiperemia y granulomas glóticos.

Internamento não planejado após cirurgia ambulatorial: estudo retrospectivo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Cure de hernie inguinale en ambulatoire [Outpatient hernia surgery].

Inguinal hernias are frequent and have an enormous socio-economic impact. Surgical treatment is indicated in most of the patients to relieve symptoms and to prevent complications. Modem treatment should focus on low complication and recurrence rates, short recovery times, and--last but not least acceptable costs. Inguinal hernia repair can be carried out by an open or minimal invasive approach. Surgery is traditionally performed under general anesthesia, but local or locoregional anesthesia are other feasible options. Nowadays, inguinal hernia surgery can easily performed as an outpatient procedure. However, stringent selection criteria, an optimized infrastructure and a close and standardized follow-up are mandatory prerequisites in order to obtain excellent results under secure conditions.

The rate of outpatient cataract surgery in ten European countries: an analysis using data from the SHARE survey

BACKGROUND: The aim of this study was to determine the rates of outpatient cataract surgery (ROCS) in ten European countries and to find country-specific health indicators explaining the differences. METHODS: Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), 251 eligible respondents were identified for which cataract surgery was the last surgical procedure. The ROCS of ten countries were compared using logistic regression. The influence of the public expenditure on health as per cent of the total expenditure on health, of the number of acute care beds per 1,000 population, and of the number of practicing physicians per 1,000 population, was studied by multiple logistic regression. Additional information was obtained from country-specific opinion leaders in the field of cataract surgery. RESULTS: The ROCS differed significantly between the ten analysed European countries where Denmark had the highest (100%) and Austria the lowest (0%) rate of day care surgery. A decrease in the density of acute care beds (p < 0.0000001) and in the density of practicing physicians (p < 0.05) and an increase in the public expenditure on health as per cent of the total health expenditure (p < 0.01) lead to an increase in the ROCS. According to the opinion leaders, regulations and financial incentives also have a strong influence on the ROCS. CONCLUSIONS: The outpatient rate of cataract surgery in the ten European countries was mainly influenced by the acute-care beds density, but also by the density of practicing physicians, and by the public expenditure on health.

Is Silver Nitrate Pleurodesis for Patients with Malignant Pleural Effusion Feasible and Safe When Performed in an Outpatient Setting?

The purpose of this study was to analyze the effectiveness and safety of silver nitrate pleurodesis (SNP) in patients with recurrent malignant pleural effusion (RMPE) when performed in an outpatient setting. Prospective study including patients with RMPE recruited in a tertiary university-based hospital from February 2008 to June 2009. Elected patients underwent pleural catheter insertion (Day 1) followed by 0.5% SNP (Day 2), and on 7th day the drain was removed. All procedures were performed in an outpatient facility. Pleurodesis was considered successful when no additional pleural procedure was necessary by the 30th day. Complications were registered and graded according to the CTCAE3.0. Quality of life was evaluated before and 30 days after SNP. A total of 68 patients (54 female, 14 male, mean age: 57.3 years) were included. In addition, 7 had bilateral pleural effusions; therefore, 75 hemithoraces were drained. Also, 5 were excluded, and 70 hemithoraces (63 patients) underwent SNP. During the period of 30 days postpleurodesis, 8 deaths not related to the procedure occurred, and we lost contact with 10 patients who were followed elsewhere. At the 30th day, 48 hemithoraces (45 patients) were reevaluated, and 2 recurrences observed. The most frequent complication was pain-graded as 3 or more in 7 patients; infection occurred in 2 patients. Physical and environmental aspects of quality of life improved significantly after pleurodesis. In this study, SNP could be performed safely in an outpatient setting, with pain the most frequent complication. Recurrences occurred in 4% of the patients.

Randomised controlled trial of telemedicine for new neurological outpatient referrals

Objective-To test the hypothesis that telemedicine for new patient referrals to neurological outpatients is as efficient and acceptable as conventional face to face consultation. Methods-A randomised controlled trial between two groups: face to face (FF) and telemedicine (TM). This study was carried out between a neurological centre and outlying clinics at two distant hospitals linked by identical medium cost commercial interactive video conferencing equipment with ISDN lines transmitting information at 384 kbits/s. The same two neurologists carried out both arms of the study. Of the 168 patients who were suitable for the study, 86 were randomised into the telemedicine group and 82 into the face to face group. Outcome measures were (I) consultation process: (a) number of investigations; (b) number of drugs prescribed; (c) number of patient reviews and (2) patient satisfaction: (a) confidence in consultation; (b) technical aspects of consultation; (c) aspects surrounding confidentiality. Diagnostic categories were also measured to check equivalence between the groups: these were structural neurological, structural non-neurological, nonstructural, and uncertain. Results-Diagnostic categories were similar (p>0.5) between the two groups. Patients in the telemedicine group had significantly more investigations (p=0.001). There was no difference in the number of drugs prescribed (p>0.5). Patients were generally satisfied with both types of consultation process except for concerns about confidentiality and embarrassment in the telemedicine group (p=0.017 and p=0.005 respectively). Conclusion-Telemedicine for new neurological outpatients is possible and feasible but generates more investigations and is less well accepted than face to face examination.

Chirurgie de l'avant-pied: quoi de neuf [What's new in forefoot surgery].

New implants and instruments have recently emerged in foot surgery. However, an additional and important development is the technique of minimally invasive surgery. As a result of new surgical approaches some common foot deformities can be corrected in a percutaneous manner. The benefits include improved wound healing, less pain, faster recovery, and less need for outpatient care. The main indications for such a technique are hallux valgus, correction of the lesser metatarsals, hallux rigidus, and some diabetic foot deformities.

Réhabilitation améliorée après chirurgie--L'ere de la prise en charge optimale du patient chirurgical [Enhanced Recovery After Surgery--optimal management of the surgical patient].

Enhanced Recovery After Surgery (ERAS) is a multimodal, standardized and evidence-based perioperative care pathway. With ERAS, postoperative complications are significantly lowered, and, as a secondary effect, length of hospital stay and health cost are reduced. The patient recovers better and faster allowing to reduce in addition the workload of healthcare providers. Despite the hospital discharge occurs sooner, there is no increased charge of the outpatient care. ERAS can be safely applied to any patient by a tailored approach. The general practitioner plays an essential role in ERAS by assuring the continuity of the information and the follow-up of the patient.

Resultate und ausser- gewöhnliche Komplikationen der Chirurgie der Gehörgangexostosen [Results and extraordinary complications of surgery for exostoses of the external auditory canal].

We present a retrospective study on 22 operations of exostosis of the external auditory canal in 20 patients. 8 patients were passionated by water sports. The most frequent indication for surgery (13 operations) was recurrent external otitis or ceruminal obstruction. In 7 cases the need for a wider access to the middle ear indicated surgery. Surgery was usually performed as an outpatient procedure, maximum hospitalization was 3 days. The mean healing period was 6 (3-10) weeks. Mean follow up was 43 (3-110) months. There were no severe intraoperative complications such as facial paresis, lesions of the ossicles or of the inner ear. As intraoperative complications we found 2 perforations of the tympanic membrane, 2 expositions of the capsule of the mandibular joint, one of which was followed by chronic pain. As postoperative complications we found an early soft tissue stenosis of the external auditory canal and one late soft tissue stenosis which recurred after revision surgery. No recurrence of exostosis was seen. We describe an up to now unknown complication: the appearance of bilateral petrositis caused by staphylococcus epidermidis after bilateral surgery in an otherwise healthy patient. This study confirms that severe complications are rare, minor ones however relatively common. And that also minor complications may have a troublesome follow. Therefore and because of the potential of severe complications indication for surgery must be made cautiously and risks of the operation must not be underestimated.

Postoperative pain management after ambulatory surgery. A survey of anaesthesiologists

Data on practice and quality of postoperative pain treatment by anaesthesiologists after ambulatory surgery are sparse. The current survey enrolled anaesthesiologists in private practice who were responsible for pain therapy after ambulatory surgery. The aim of this investigation was to evaluate the implementation of the German S3 guidelines for acute and postoperative pain therapy in the outpatient setting.