Objective To understand the current situation of ambulatory surgery cancellation rates and the reasons for cancellation. Methods China National Knowledge Infrastructure, Wanfang data, VIP database, Embase, Web of Science, PubMed and Cochrane Library were systematically searched for literature reporting cancellation of ambulatory surgery and published between January 1st, 2000 and September 1st, 2023. Data extraction and meta-analysis were conducted after literature screening, and subgroup analyses were conducted based on the type of the ward, reasons for cancellation, and study sites. Results A total of 19 studies were included, with a total of 270528 cases of ambulatory surgeries, among which 12250 cases were cancelled. The ambulatory surgery cancellation rate was 5.8% [95% confidence interval (CI) (4.5%, 7.1%)]. Subgroup analyses showed that the cancellation rates of general wards, pediatric wards, and ophthalmic wards were 4.0% [95%CI (2.9%, 5.1%)], 9.9% [95%CI (5.2%, 14.5%)], and 8.1% [95%CI (2.7%, 13.4%)], respectively, and the difference in the cancellation rate among different types of wards was statistically significant (P=0.02); there was a significant difference in the surgery cancellation rate among different reasons for cancellation (P<0.01), the highest cancellation rate of surgery was due to disease factors, which was 2.5% [95%CI (1.2%, 3.9%)]; there was no statistically significant difference in the cancellation rate among different study sites (P=0.43). Conclusions The issue of cancellation of ambulatory surgery is prominent in clinical practice. Optimized management is therefore suggested in urgent.
Objective To explore the effect of multimodal pain management in the perioperative period of ambulatory laparoscopic cholecystectomy. Methods Non-randomized historical control method was adopted. Patients who underwent laparoscopic cholecystectomy in the Day Surgery Center of West China Hospital, Sichuan University were included. The patients who received single modal pain management between January and May 2020 were taken as the control group, and the patients who received multimodal pain management between January and May 2021 were taken as the trial group. The postoperative pain and pain-related indicators of the two groups were compared. Results A total of 731 patients were included, including 496 in the trial group and 235 in the control group. There was no significant difference in gender, age, body mass index, nationality, education level, diagnosis, marriage and occupation between the two groups (P>0.05). There were 41 patients with moderate or above pain after surgery in the trial group, of which 3 patients were accompanied by severe nausea and vomiting. There were 41 patients with moderate or above pain after surgery in the control group, of which 4 patients were accompanied by severe nausea and vomiting. The incidence of moderate or above postoperative pain (8.3% vs. 17.4%) and post-discharge pain (0.0% vs. 1.3%) in the trial group were lower than those in the control group (P<0.05). There was no significant difference in the incidence of postoperative severe nausea and vomiting and delayed discharge due to postoperative pain between the two groups (P>0.05). There was no statistically significant difference between the two groups patients with moderate or above pain in gender, age, body mass index, education level, diagnosis, time from the onset of pain to the end of surgery, pain location, pain nature, use rate of antiemetic drugs, and score after treatment (P>0.05). The majority of pain sites were surgical incision pain, and the nature of pain was mostly swelling pain. The pain score of patients with moderate or above pain in the trial group was lower than that of the control group (4.4±0.6 vs. 4.9±1.1, P<0.05). Conclusion Multimodal pain management reduces postoperative pain of patients undergoing ambulatory laparoscopic cholecystectomy by means of assessment, medication, procedure improvement, health education, which can provide guarantee for perioperative quality management of ambulatory laparoscopic cholecystectomy.
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.
ObjectiveTo investigate the feasibility, safety, and clinical value of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction performed as day surgery for breast cancer, aiming to provide a reference for major hospitals seeking to implement a day surgery model for breast cancer treatment. Methods We retrospectively analyzed 222 patients who underwent endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction for breast cancer at West China Hospital of Sichuan University from June 2021 to December 2022 were included, and were divided into a day surgery group and a conventional inpatient group based on their admission model. The operative indicators, Breast-Q scores, preoperative waiting time, length of hospital stay, hospitalization costs and complications of the two groups were analyzed. ResultsExcept for intraoperative bleeding (P=0.007), the difference between the two groups in comparison of the rest of the operative indicators was not statistically significant (all P>0.05); there was no significant difference between the two groups in preoperative and postoperative Breast-Q scores (all P>0.05); the preoperative waiting time and length of stay in hospital of the day surgery group were 4.0 (3.0, 11.0) and 1.0 (1.0, 1.0) days, respectively, which were significantly shorter than that of the conventional inpatient group; except for postoperative pain scores (P<0.001), there was no statistically significant difference in complications between the two groups (all P>0.05).ConclusionEndoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction in day surgery is feasible and safe.Without increasing postoperative complications, it effectively reduces hospitalization costs and shortens medical care time, demonstrating significant clinical value.
Objective To describe the situation of postoperative pain management in colorectal cancer patient in enhanced recovery after surgery (ERAS) mode, and explore its influenceing factors. Methods From March to December 2017, colorectal cancer patients in ERAS mode in Department of Gastrointestinal Surgery, West China Hospital of Sichuan University were selected. On the third day after surgery, a total of 74 patients with acute pain completed a questionnaire, which was composed of a demographic form, the Houston Pain Outcome Instrument (HPOI), Self-Rating Anxiety Scale, and Social Support Rating Scale. Mean±standard deviation and percentage were used to describe the total score of pain experience, t test, analysis of variance, Spearman correlation analysis were used for single-factor analysis, and multiple linear regression was used for multi-factor analysis. Results The mean total score of pain experience was 15.1±3.8. Single-factor analysis results showed that the affection of pain on daily life (rs=0.270, P=0.020), satisfaction of pain controlling education (rs=–0.283, P=0.015), subjective support (rs=–0.326, P=0.005), and social support utilization (rs=–0.253, P=0.029) were correlated with the total score of pain experience. Multi-factor analysis results showed that satisfaction of pain controlling education (P<0.001) and subjective support (P=0.005) were negative influencing factors of postoperative pain experience score, and severe anxiety (P=0.001) and pain expectation after surgery (P=0.016) were positive influencing factors of postoperative pain experience score. Conclusions Pain management situation is not so bad in these patients. High satisfaction of pain controlling education and high subjective social support are helpful to decrease pain. The medical staff should pay more attention to patients with severe anxiety, and help patients to establish reasonable pain expectation after surgery.