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.
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 evaluate the effectivity of dexmedetomidine on the early postoperative quality of recovery in patients undergoing ambulatory knee arthroscopy under general anesthesia. Methods Patients scheduled for knee arthroscopy at the Day Surgery Center of the First Affiliated Hospital of Anhui Medical University between June and September 2024 were selected. According to the computer-generated random allocation, patients were randomly divided into the dexmedetomidine group (Dex group) and the saline control group (NS group). The Dex group received a continuous infusion of dexmedetomidine at a rate of 0.04 µg/(kg·h) until discharge, whereas the NS group was administered a comparable volume of saline. The primary outcome measure was the EuroQol Five-Dimensional Five-Level (EQ-5D-5L) score for health-related quality of life measured at the postoperative 24 hours. Secondary outcome measures included the Athens Insomnia Scale score on the night of surgery and the incidence of adverse reactions such as nausea and vomiting within 24 hours postoperatively. Results A total of 60 patients were included, with 30 patients in each group. There were statistically significant differences in the EQ-5D-5L health scores at the postoperative 24 hours (0.857±0.081 vs. 0.721±0.098) and the Athens Insomnia Scale scores [2.00 (2.00, 3.00) vs. 4.00 (3.00, 5.25)] on the night of surgery between the Dex group and the NS group (P<0.05). The difference in the incidence of postoperative nausea and vomiting between the two groups was not statistically significant [1 case (3.3%) vs. 5 cases (16.7%); χ2=1.667, P=0.197]. No adverse reactions such as bradycardia, hypotension, urinary retention, respiratory depression, dizziness and lethargy occurred in both groups. Conclusion Dexmedetomidine can significantly improve the early postoperative quality of life and sleep in patients undergoing ambulatory knee arthroscopy, thereby facilitating early postoperative quality of recovery.
Objective To explore whether bundled care for anesthesia management can reduce the risk of postoperative nausea and vomiting (PONV). Methods The data of laparoscopic cholecystectomy patients admitted to the Day Surgery Center of West China Hospital, Sichuan University between July and November 2021 were retrospectively collected. Patients were divided into a bundled care group and a control group based on whether anesthesia management was implemented according to the bundled care. The demographic characteristics, intraoperative anesthesia management methods, postoperative conditions, and incidence of PONV between the two groups of patients were analyzed and compared. Results A total of 314 patients were included. Among them, there were 124 cases in the bundled care group and 190 cases in the control group; PONV occurred in 52 cases, the incidence of PONV was 16.6% (52/314). Except for surgical time and postoperative incision infiltration (P>0.05), there were statistically significant differences in age, gender, body mass index, anesthesia time, airway establishment, and postoperative analgesic use between the two groups of patients (P<0.05). There was no statistically significant difference in the occurrence of PONV between the bundled care group and the control group (17 vs. 35 cases; χ2=1.205, P>0.05). The results of logistic regression analysis showed that PONV was correlated with gender [odds ratio=0.107, 95% confidence interval (0.030, 0.375), P<0.001], and using bundled care [odds ratio=0.388, 95% confidence interval (0.169, 0.894), P=0.026]. Conclusions Women are at high risk of PONV among patients undergoing day laparoscopic cholecystectomy. The risk of PONV is lower when using bundled care.
ObjectiveTo analyze the efficacy of promoting the development of day surgery in a municipal third-level public hospital under the guidance of national hospital performance appraisal system. MethodThe annual data relevant day surgery in the Yibin Second People’s Hospital were collected from 2016 to 2022, which were divided into three stages: 2016–2018, 2019–2020, and 2021–2022. The trend and correlation of the performance appraisal indicators were analyzed. ResultsThe day surgery in the Yibin Second People’s Hospital started in 2018, and its proportion in the elective surgery was only 1.2% in 2018, then increased continuously after the implementation of performance appraisal system, and was up to 34.7% in 2022. From 2016 to 2022, the proportion of discharged patients underwent surgery in the entire hospital increased continuously from 22.4% in 2016 to 35.7% in 2022, and the average hospital stay in the entire hospital gradually decreased from 10.9 d to 8.1 d, which both had a significant linear correlation with the proportion of day surgery in the elective surgery (rs=0.93, P=0.002; rs=–0.99, P<0.001, respectively). In the recent implementation of performance appraisal system, the re-operation rate after day surgery was less than 0.1%, the readmission rate of day surgery after discharge was 0%, and the satisfaction rate of day surgery patients was more than 95.0%, which reached 97.0% by 2022, higher than the average level of inpatient satisfaction in the entire hospital. Taking laparoscopic cholecystectomy, cataract phacoemulsification and intraocular lens implantation, internal fixation extraction, vocal cord polypectomy, and endoscopic gastric polypectomy as example, the average total hospitalization cost and average cost excluding drug and medical materials consumption of the day surgery all decreased compared to non-day-surgery mode, respectively. ConclusionUnder the guidance of national hospital performance appraisal system, day surgery has entered a rapid developing stage, but it is still necessary to promote the medical quality by standardized, precise, and informationized day surgery management.
Objective To analyze the factors influencing day surgery developing towards same-day surgery, and provide a reference for the promotion of same-day surgery. Methods A questionnaire on influencing factors of same-day surgery was prepared based on structural equation modeling (SEM), including 6 dimensions and 23 items. From January to October 2021, at the Day Surgery Center of West China Hospital, Sichuan University, the random sampling method was used to select the research subjects for a questionnaire survey, and SEM was used to analyze the factors impacting the iterative development of day surgery to same-day surgery service model. Results A total of 200 questionnaires were distributed, and 192 valid questionnaires were recovered, with an effective recovery rate of 96.0%. The Cronbach’s α coefficient of the questionnaire was 0.857, and the Cronbach’s α coefficient of each dimension was from 0.832 to 0.934. The KMO test value was 0.822, and the result of Bartlett sphericity test was χ2=4568.330, P<0.001. The model fit indexes met the standard requirements well. The result of SEM revealed that the standard path coefficients of “the hospital’s preliminary preparation for day surgery developing towards same-day surgery” impacting “the guarantee system related to surgical quality and safety”, “the guarantee system related to surgical quality and safety” impacting “the public’s awareness of day surgery developing towards same-day surgery”, “the guarantee system related to surgical quality and safety” impacting “the ‘hospital-community’ integrated collaboration network”, “the public’s awareness of day surgery developing towards same-day surgery” impacting “the ‘hospital-community’ integrated collaboration network”, and “the ‘hospital-community’ integrated collaboration network” impacting “the iterative upgrade of day surgery” were all larger than 0.5, indicating strong influences between these factors, but the absolute value of standard path coefficient of the “hospital’s development brought by the transform of day surgery to same-day surgery” impacting “the guarantee system related to surgical quality and safety” was smaller than 0.3. Conclusion The hospital’s preliminary preparation, the guarantee system related to surgical quality and safety, the development of the “hospital-community” integrated collaboration network, and the public’s awareness are the probable factors influencing the iterative development of day surgery to same-day surgery.
Objective To analyze the current status of day surgery in West China Hospital of Sichuan University and compare it with the Recommended Catalogue of Day Surgery (2022 Edition), in order to provide reference for the update and expansion of day surgery procedures in hospitals. Methods The day surgical procedures carried out in West China Hospital of Sichuan University from October 2009 to July 2023 were collected. The day surgical procedures were classified based on surgical specialties, types of procedures, methods of operation, and surgical grading, etc. The day surgical procedures in West China Hospital of Sichuan University were compared with those in the Recommended Catalogue of Day Surgery (2022 Edition). Results A total of 576 types of daytime surgeries were carried out in West China Hospital of Sichuan University, involving 15 specialties. A total of 662 types of day surgeries were recommend in the nationally recommended catalogue for daytime surgery, involving 11 specialties. Among the nationally recommended surgical procedures, West China Hospital of Sichuan University had carried out 233 types of surgical procedures, and 26 additional types of surgical procedures were carried out as outpatient surgeries. According to the classification of surgical difficulty, the Level Ⅱ and Ⅲ surgeries were mainly carried out in West China Hospital of Sichuan University, and the Level Ⅱ surgeries were mainly recommend in the nationally recommended catalogue for day surgery. Conclusions The high-quality development of day surgery in China should not be limited to the supplement of surgical procedures. It is necessary to strive to increase the proportion of minimally invasive and fourth-level surgeries while ensuring medical quality and safety, and improve the overall medical level of day 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.
Objective To explore the Shanghai featured day surgery directory to provide policy support for further promoting the development of day surgery and focusing on appropriate diseases. Methods The data of day surgery patients discharged from Shanghai municipal hospitals within 24 hours between January 1 and September 30, 2021 or between January 1 and September 30, 2022 were collected. The number of day surgical cases, average cost and the trend of surgical diseases in 2021 and 2022 were compared. The day surgical diseases suitable for normalized epidemic prevention and control were summarized. Results A total of 35 municipal hospitals were included, including 175 201 patients. A total of 107 101 operations were performed in 2021 and 68 100 in 2022. In the second quarter of 2022, affected by the epidemic situation in Shanghai, the number of cases undergoing day surgery decreased significantly, and the average cost was not significantly affected by the epidemic situation. In 2022, 27 of the day surgery carried out in Shanghai municipal hospitals did not appear in the national recommended directory, and the number of operations for 6 diseases recovered rapidly under the normalized epidemic prevention and control. Conclusion Vigorously implementing day surgery can improve the utilization rate of hospital beds, speed up the turnover of patients, improve the utilization rate of medical resources, and reduce the hospitalization time of patients, the waiting time for surgery and the accompanying time of family members to meet the epidemic prevention requirements.
ObjectiveTo observe the effect of transabdominal preperitoneal (TAPP) laparoscopic hernia repair by same-day surgery mode for patients with inguinal hernia. MethodsThe patients who underwent TAPP laparoscopic hernia repair were retrospectively collected in the Day Surgery Center of West China Tianfu Hospital from July 2022 to June 2023. All patients in this study were admitted according to the same-day surgery plan, and those who were admitted to the hospital on the same day, operated on the same day, and returned to their homes on the same day, i.e., those who did not stay in the hospital overnight (the same-day surgery plan of the West China Tianfu Hospital of Sichuan University is now basically in the range of 8∶00–20∶00, and the latest discharge is at 21∶00) were classified as the same-day surgery group; however, the patients whose special cases needed to be postponed due to the condition of their illnesses, or those who were discharged from the hospital after 21∶00 due to safety considerations because of other reasons such as postoperative observation of patients with general anesthesia for a period of less than 2–4 h, or those who had a strong desire to be admitted to the hospital overnight, and whose hospital stay was not more than 24 h, were classified as the non-same-day surgery group. The age, gender, marital status, body mass index, hernia type, surgical site, home address, intraoperative bleeding, operative time, total hospitalization cost, pain score at discharge, unplanned revisit rate within 30 d after surgery, discharge satisfaction were compared between the patients of two groups. ResultsA total of 167 patients underwent TAPP laparoscopic hernia repair were enrolled in this study, including 97 in the same-day surgery group and 70 in the non-same-day surgery group. There were no statistically significant differences in the age, gender, marital status, body mass index, hernia type, surgical site, intraoperative bleeding, operative time, and total hospitalization cost between the two groups (P>0.05). However, it was found that the patients in the non-same-day surgery group had a higher pain score at discharge and a higher proportion of home address outside Chengdu city as compared with the same-day surgery group (P=0.042, P<0.001, respectively); The satisfaction rate of all patients in this group was 100% on the 28th day after discharge, and the unplanned revisit rate within 30 d after surgery was 3.6% (6/167), although which in the same-day surgery group was slightly higher than the non-same-day surgery group, the difference was not statistically significant by Fisher test [4.1% (4/97) versus 2.9% (2/70), P=0.226]. ConclusionFrom the analysis results of this study, TAPP laparoscopic hernia repair for patients with inguinal hernia by the same-day surgery mode is safe, and it can further shorten the hospitalization time as compared with the non-same-day surgery.