ObjectiveTo evaluate changes in operational effectiveness after the implementation of ambulatory surgical management in pars plana vitrectomy (PPV). MethodsA retrospective clinical study. 17 528 surgeries in 10 895 eyes of 10 895 patients who underwent minimally invasive PPV on an ambulatory and/or inpatient basis at Tianjin Medical University Eye Hospital from August 2015 to June 2023 were included in this study. Among them, 5 346 eyes in 5 346 cases were male; 5 549 eyes in 5 549 cases were female. The age ranged from 0 to 95 years, with the mean age of (57.74±13.15) years. 6 381 surgeries in 3 615 eyes from August 2015 to December 2018 (the initial period of day surgery) were used as the control group; 11 147 surgeries in 7 280 eyes from January 2019 to June 2023 (the expanded period of day surgery) were used as the observation group. According to the management mode of ambulatory surgery, the observation group was subdivided into the decentralized management group (January 2019 to December 2020) and the centralized management group (January 2021 to June 2023), with 2 905 and 4 375 eyes and 4 646 and 6 501 surgeries, respectively. Changes in the percentage of day surgery, average hospitalization days, and average unplanned reoperation rate were compared. The Mann-Whitney U test was used to compare numerical variables between groups; the chi-square test or Fisher's exact test was used to compare categorical variables. ResultsThe number of cases of daytime PPV performed in the observation group and control group was 7 852 (70.44%, 7 852/11 147) and 24 (0.38%, 24/6 381) cases, respectively, and the average hospitalization days were 1 (1) and 5 (3) d. Compared with the control group, the observation group had a significantly higher percentage of day surgery (χ2=8 051.01) and a considerably lower mean hospitalization day (Z=4 536 844.50), and the differences were statistically significant (P＜0.000 1). The mean hospitalization days in the decentralized and centralized management groups were 2 (3) and 1 (0) d, respectively, and unplanned reoperations were 34 (0.73%, 34/4 646) and 171 (2.63%, 171/6 501) eyes, respectively. Compared with the decentralized management group, average hospitalization days was significantly lower (Z=1 436.94) and unplanned reoperation rate was significantly higher (χ2=54.10) were significantly lower in the centralized management group, both of which were statistically significant (P＜0.000 1). ConclusionPPV ambulatory management model can significantly reduce the average hospitalization day, but also results in higher rates of unplanned reoperations.
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.
With the continuous development of medical technology, ambulatory surgery or day surgery is becoming a new and very efficient medical service model in China. However, infection prevention and control in ambulatory surgery center has not yet attracted the attention of infection control practitioners. This paper analyzes the necessity, status quo, and entry point of infection prevention and control work in ambulatory surgery centers. Recommendations in the field of risk assessment, engineering control, behavior management, surveillance, and antimicrobial stewardship are provided to infection control practitioners as well.
Although the ambulatory surgery started late in France, it has a unique set of definitions and criteria for defining the scope. In France, the time required for ambulatory surgery is more stringent, and the ambulatory surgery center is open for no more than 12 hours to control the total length of treatment. The patients should enter the ambulatory surgery center in the morning and leave it before the end of afternoon. The development of ambulatory surgery in France is stable and continuous. This article introduces the development of French ambulatory surgery from the origin, development and future of French ambulatory surgery, organizational management and clinical path, in order to promote the standardization of Chinese ambulatory surgery management.
ObjectiveTo explore the feasibility of radiofrequency ablation of great saphenous varicose veins in ambulatory surgery.MethodsPatients who underwent radiofrequency ablation of great saphenous varicose veins between May 2018 and June 2019 in General Hospital of Northen Theater Command were prospectively selected. According to their choices of treatment modes, patients were divided into two groups, day surgery group and routine inpatient group. The preoperative waiting time, length of hospital stay, and hospitalization expenses of the two groups were compared. The postoperative pain, tenderness, and complications were followed up on the first day (the next day after operation), the third day, and the fourteenth day after operation, and the time of return to normal life and work and patients’ satisfaction in two groups were recorded.ResultsA total of 95 patients were enrolled, including 52 in the day surgery group and 43 in the routine inpatient group. There was no significantly difference in age, gender, heart rate, mean arterial pressure, or operation time between the two groups (P>0.05). Compared with the routine inpatient group, the day surgery group had shorter preoperative waiting time, shorter length of hospital stay, and lower hospitalization expenses (P<0.05). In the day surgery group, the time of return to normal life and the time of return to work were shorter and patients’ satisfaction was significantly higher than those in the routine inpatient group (P<0.05). There was no significant difference in pain, tenderness, or paresthesia scores between the two groups after surgery according to the follow-up assessment (P>0.05); the pain, tenderness, and paresthesia scores on the first day and the third day were significantly different from those on the fourteenth day after surgery, indicating that the longer the postoperative time of the two groups, the less pain, tenderness, and paresthesia scores were.ConclusionRadiofrequency ablation of great saphenous varicose veins in ambulatory surgery has a short hospital stay, low medical cost, high patient satisfaction, and can ensure the safety of treatment at the same time, which is worthy of clinical promotion
Ambulatory surgery ward is a fast and effective way of treating, nursing and patients’ education. We report the practice of ambulatory surgery ward in West China Hospital of Sichuan University about patients’ reception, treatment and nursing, medical safety, health education and post-operative follow-up. Results show that ambulatory surgery ward would guarantee patients’ safety, shorten hospitalization days and decrease medical cost, with more than 98% of patients’ satisfaction.
Objective To investigate the cancellation of ambulatory surgeries based on doctor-patient assistants, analyze the reasons, and propose corresponding strategies in order to improve the utilization of medical resources and the operational efficiency of hospitals. Methods A retrospective analysis was conducted on patient data between May 2021 and October 2023, who successfully scheduled surgery at the Day Surgery Center of the First Affiliated Hospital of the Air Force Military Medical University and cancelled the surgery due to various reasons. The reasons for the cancellation were also analyzed. Results A total of 5691 surgeries were scheduled, and 27 surgeries were cancelled before admission, with a cancellation rate of 0.47%. A total of 5607 surgeries were completed, and 57 surgeries were cancelled on the day of surgery, with a cancellation rate of 1.01%. Among all departments, patients in Gastrointestinal Surgery Department and Urology Department had the highest cancellation rates before admission (1.61% and 0.68%, respectively), and the highest cancellation rates on the day of surgery (1.43% and 1.38%, respectively). The most common reason for cancellation before admission was surgical doctor business travel/other arrangements (22.22%). The most common reason for cancellation on the day of surgery was preoperative respiratory infections in patients (14.04%). ConclusionsThe establishment of doctor-patient assistant positions can to some extent help reduce the cancellation of ambulatory surgery before admission and on the day of surgery. For patients undergoing ambulatory surgery, preoperative education and evaluation should be strengthened, and management processes and systems should be improved, in order to reduce the cancellation rate of ambulatory surgery and improve hospital operational efficiency.
ObjectiveTo explore and analyze the current situation of discharge readiness and delayed discharge for patients undergoing ambulatory thyroid malignancy surgery.MethodsBy convenient sampling, 284 thyroid malignancy patients who were admitted to the day surgery ward of Xiangya Hospital, Central South University from September 1st to December 30th, 2018 were selected as the research objects. The general information questionnaire and Readiness for Hospital Discharge Scale (RHDS) were used as the research tools. Descriptive statistical analysis was used to analyze the demographic statistics of the patients, and the differences of different dimension scores and total scores of RHDS were analyzed based on the basic information of patients.ResultsThe total score of RHDS was 8.66±0.60 for patients, including 6.31±0.74 for dimension of physical condition, 9.49±0.87 for dimension of disease knowledge, 9.20±0.99 for dimension of coping ability after discharge, and 9.63±0.74 for dimension of expected social support. The delayed discharge rate was 2.1%. There was no significant difference in the scores of different dimensions or total scores in RHDS of patients undergoing ambulatory thyroid malignancy surgery with different gender, age, education level or whether there was a special person to take care of them (P>0.05). There were differences between patients with delayed discharge and the ones without delayed discharge in the three dimensions namely physical condition, disease knowledge, and coping ability, as well as the total scores (P<0.05), while there was no statistically significant difference in the scores of expected social support dimension (P>0.05).ConclusionsThe discharge readiness for patients undergoing ambulatory thyroid malignancy surgery is good. The medical staff should provide health intervention measures according to the specific situation of patients, so as to improve the quality of discharge guidance, and ensure the safety of patients.
Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
ObjectiveTo explore the utility and advantage of same-day surgery mode of Mammotome minimally invasive operation (MMT) in ambulatory surgery center, and summarize the key points of clinical management.MethodsFemale patients who underwent MMT in West China Hospital of Sichuan University between June and December 2019 were included. According to the operation mode, the patients were divided into same-day surgery group and routine group (routine day operation). The perioperative data were analyzed.ResultsA total of 1 297 female patients were included. Among them, 571 cases were in the same-day surgery group and 726 cases were in the routine group. There was no significant difference in baseline data, intra-operative bleeding volume, operation time, or complication rate between the two groups (P>0.05). There were significant differences in the number of masses (χ2=13.384, P<0.001), pathological type (χ2=11.990, P=0.007) and operation method (χ2=89.185, P<0.001). The length of hospital stay in the same-day surgery group was significantly shorter than that in the routine group (Z=–29.746, P<0.001); the cost of biopsy (Z=–8.549, P<0.001), the cost of surgical instruments (Z=–9.564, P<0.001), and the total cost of hospitalization (Z=–10.378, P<0.001) in the same-day surgery group were less than those in the routine group. In addition, the result of generalized estimating equation showed that the postoperative pain scores of patients in the same-day surgery group were lower than those in the routine group (P<0.001).ConclusionsThe same-day surgery mode of MMT is safe and feasible with high time economic benefits, which is worthy promoting in ambulatory surgery center. Cautions should addressed with patients’ safe and high-quality health education.