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.
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.
Day surgery has been developed in China for over 30 years. However, the admission decisions for day surgery patients are still mainly based on expert experience, brainstorming, and institutional recommendation, and lack scientific admission criteria and universality. West China Hospital of Sichuan University has implemented methods such as semi-supervised learning based on heterogeneous data, to construct a more objective and accurate patient admission model based on large amounts of diagnosis and treatment data. This initiative aims to assist the country and hospital in reducing medical costs and alleviating the acute problem of the current contradiction between supply and demand of medical resources. It also seeks to optimize the utilization and allocation of bed resources, reduce the cost of patient management, enhance the theoretical research on patient admission methods in day surgery in China, and provide reference and inspiration for other hospitals in the day surgery industry 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 explore the application effect of same-day surgery mode in adult patients with inguinal hernia repair under enhanced recovery after surgery mode. Methods The perioperative data of adults undergoing inguinal hernia repair in the Day Surgery Center of West China Hospital, Sichuan University between August 2020 and March 2022 were analyzed retrospectively. The adult patients with inguinal hernia repair who received routine daytime surgery were taken as the control group (routine group), and the adult patients with inguinal hernia repair who received same-day surgery were selected as the trial group (same-day group). The differences in safety, cost and patient experience between the two groups were compared and analyzed. Results A total of 319 patients were included, including 152 in the routine group and 167 in the same-day group. There was no significant difference in gender, education level, occupation and hernia ring diameter between the two groups (P>0.05). The age of the patients in the same-day group was older than that in the routine group [(49.49±12.88) vs. (46.41±14.12) years, P<0.05]. The hernia position of the two groups was mostly on the right side, but there was a difference in the hernia position (P<0.05). In terms of safety indicators, the majority of patients in the two groups used local anesthesia. The proportion of local anesthesia (98.2% vs. 76.3%), the amount of intraoperative bleeding [2.8 (2.0, 5.0) vs. 1.3 (0.0, 5.0) mL] in the same-day group were higher than those in the routine group, and the operation time [25.2 (20.0, 33.0) vs. 32.3 (26.0, 40.7) min] in the same-day group was shorter than that in the routine group (P<0.05). There was no significant difference between the two groups in the time of getting out of bed and the complications rate on the 3rd and 28th days after operation (P>0.05). There were no intraoperative complications in both groups. In terms of cost indicators, there was no significant difference between the two groups in the hospitalization cost (P>0.05). The surgery cost of the same-day group was higher than that of the routine group [1472.0 (1438.1, 1614.6) vs. 1450.3 (1428.1, 1438.1) yuan, P<0.05]. The drug cost [109.2 (81.3, 138.7) vs. 255.8 (127.0, 261.6) yuan] and the total medical cost [8418.5 (8207.4, 9129.9) vs. 8912.1 (8325.9, 9177.9) yuan] in the same-day group were lower than those in the routine group (P<0.05). In terms of patient experience indicators, the postoperative pain score [0.3 (0.0, 1.0) vs. 0.2 (0.0, 0.0)] and satisfaction score [3.3 (3.0, 4.0) vs. 3.0 (3.0, 3.0)] of the same-day group were higher than those of the routine group (P<0.05). Conclusion Both the same-day surgery mode and the routine surgery mode of adult patients with inguinal hernia repair have high safety, but the same-day surgery mode is more economical and patient satisfaction is higher than the routine surgery mode, which suggest that the same-day surgery mode of adult patients with inguinal hernia repair under enhanced recovery after surgery mode is feasible, safe and economic, and further optimizes and improves the content and quality of daytime surgical medical services.
Objective To explore the application effect of the clinical pathway for perianal day surgery based on enhanced recovery after surgery (ERAS) concept. Methods The case data of patients who underwent perianal surgery in the Department of Anorectal Surgery of Gansu Provincial Hospital between January and October 2023 and patients who underwent perianal day surgery based on the ERAS clinical pathway in the Ambulatory Surgery & Chemotherapy Centre of Gansu Provincial Hospital were retrospectively collected. The patients in the Department of Anorectal Surgery were defined as the control group, while the patients in the Ambulatory Surgery & Chemotherapy Centre were defined as the pathway group. The differences in indicators such as hospitalization cost, average hospitalization time, preoperative hospitalization time, surgical time, intraoperative bleeding, patient satisfaction, and postoperative follow-up between the two groups of patients were analyzed. Results A total of 400 patients were included, with 200 in each group. The differences between the two groups in gender and age were not statistically significant (P>0.05), the Visual Analogue Scale of the pathway group was lower than that of the control group (P<0.05), and the Kolcaba Comfort Scale score was higher than that of the control group (P<0.05). The hospitalization cost, average hospitalization time, preoperative hospitalization time, and surgical time of the pathway group were all lower than those of the control group (P<0.05), and there was no statistically significant difference in intraoperative bleeding between the two groups (P>0.05). The satisfaction rates of the pathway group and the control group were 90.5% and 86.0%, respectively, and there was no statistically significant difference between the two groups (P>0.05). The follow-up results showed that perianal day surgery did not increase the discomfort of patients after discharge. Conclusions The clinical pathway for day surgery based on ERAS concept is more conducive to the postoperative recovery of patients undergoing day surgery, reducing medical costs, improving medical quality, and increasing patient satisfaction. It is worthy of clinical promotion and application.
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.
As the concept of enhanced recovery after surgery (ERAS) has promoted the revolution of day surgery, more complicated surgery such as radical resection of early cancer and other fourth-level surgery can be performed in day surgery mode. Since 2010, West China Hospital of Sichuan University has introduced ERAS program and gradually performed fourth-level surgery in day surgery center. With the measures of reasonable inclusion criteria, team construction, and optimization of treatment and nursing procedures, the quality and safety of day surgery are guaranteed. Between January 2019 and August 2023, a total of 2531 patients underwent 24-hour fourth-level day surgery for early cancer, with a delayed discharge rate of 2.09%, a readmission rate of 2.57%, and a readmission rate of 1.11%, without death case, and the patient satisfaction was above 98%. The perioperative management scheme of fourth-level day surgery provides a reference for the management of day surgery for more diseases.
Objective To classify the nursing needs of patients undergoing ophthalmic day surgery, to understand the characteristics and needs of different patient groups, and propose specific nursing strategies to further improve the nursing quality of the ophthalmic day wards. Methods A retrospective review was conducted on all archived electronic medical records of patients in the Ophthalmology Day Ward of Beijing Tongren Hospital affiliated to the Capital Medical University from January to September 2023. Statistical description and cluster analysis were used to analyze and cluster all data. Results A total of 52049 patients were included, with an average age of (57.11±19.61) years. The number of nursing items required was 0 for 3104 patients (5.96%), 1 for 9158 patients (17.59%), 2 for 25428 patients (48.85%), 3 for 8812 patients (16.93%), 4 for 5442 patients (10.46%), and 5-11 for 105 patients (0.20%). The number of patients’ comorbidities was 0 for 38653 patients (74.26%), 1 for 10896 patients (20.93%), 2 for 2449 patients (4.71%), and 3-11 for 51 patients (0.10%). Using the number of comorbidities, total required nursing care items, and age as clustering variables, the 52049 patients were divided into 3 groups: low nursing demand group with 11817 patients (22.70%), medium nursing demand group with 24466 patients (47.01%), and high nursing demand group with 15766 patients (30.29%). The results showed that both patient age and the number of comorbidities were closely related to the number of nursing care items needed. Conclusion Classifying and analyzing the nursing needs of patients undergoing ophthalmic day surgery can help understand the needs of different categories of patients, improve nursing strategies specifically, provide support for further improving the accuracy and quality of ophthalmic day care services, and provide reference for clinical nursing work.
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.