Ambulatory Surgical Procedures

To investigate the incidence of pain following discharge from reproductive day surgery. Cross-sectional descriptive study. A public hospital for women in Melbourne. 315 women participated in phone interviews and 10 in face-to-face interviews. Self-reports of pain were assessed in relation to age, English and non-English speaking background, prior experience of day surgery, type of surgery, time in recovery, information provision prior to surgery, and access to significant others at home. Older women were less likely to report having pain immediately following discharge (regression coefficient = -0.72, 95% CI, 0.58 to 0.88, p < or = 0.01), or within 48 hours following discharge (regression coefficient = - 0.71, 95% CI, 0.57 to 0.88, p < or = 0.05). Women with a prior experience of day surgery were 1.9 times more likely to be in pain within 48 hours following surgery (regression co-efficient 1.88, 95% CI, 1.134 to 3.10, p < or = 0.05). Women who understood information were le...

Surgical strategy regarding nerve identification and resection in relation to chronic postoperative pain remains controversial. A central question is whether nerves in the operation field, when identified, should be preserved or resected. In the present study, the hypotheses that the identification and consequent resection of nerves 'at risk' have no influence on postoperative pain has been tested. A single-centre study was conducted in 525 patients undergoing Lichtenstein hernioplasty. One surgeon (364 operations, Group A) consequently resected nerves 'at risk' for being injured and nine surgeons (161 operations, Group B) adhered to the general routine of nerve preservation. All cases were ambulatory surgery on anaesthetised patients and the groups were similar with regard to age, body mass index (BMI) and preoperative pain. Self-reported pain at 3 months was recorded on a 10-box visual analogue scale (VAS). The identification and resection of nerves were continuous...

BACKGROUND Caudal anesthesia is widely used as intraoperative and postoperative analgesia in children's subumbilical surgeries such as on the urogenital system, lower extremities and lower abdomen to reduce the stress response to surgery and to facilitate the general anesthesia. AIM The purpose of this study was to compare the effects of caudally administered bupivacaine and levobupivacaine of equal volume and concentration on motor block and postoperative pain in children undergoing circumcision surgery. PATIENTS AND METHODS The prospective, randomized, double-blind study included 60 patients with ages ranging from 1-10 years and ASA (American Society of Anesthesiologists) physical status of I-II who underwent elective circumcision surgery. The patients were divided into two groups: group B received 0.5 ml/kg of bupivacaine 0.25% caudally and group L received 0.5 ml/kg of levobupivacaine 0.25% caudally. Postoperative pain was assessed by children's and infant's postoper...

Ambulatory phlebectomy is an elegant outpatient procedure for the removal of varicose veins. One of the keys to its success is the ability to perform the procedure under local anesthesia. A new form of anesthesia, tumescent anesthesia, has been developed for liposuction surgery and is now being expanded for use in other surgical disciplines. To determine the efficacy and safety as well as review the use and advantages of tumescent anesthesia in ambulatory phlebectomy. A retrospective review of phlebectomy cases performed in our offices under tumescent anesthesia. The reported level of intraoperative and postoperative pain was very low. The complication rate was consistent with other reports except for a higher number of hematomas (3.4%). Tumescent anesthesia provides a very safe, comfortable method of anesthetizing patients for ambulatory phlebectomy. Epinephrine, in appropriate concentrations, should be a part of all tumescent anesthetic solutions used for phlebectomy as it may decrease the incidence of hematoma.

Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day care procedure.

Children are not just 'small adults'. They have specific physical, psychological and social requirements that must be identified and addressed to optimise their well-being in the perioperative period. The healthcare practitioner should be trained to understand the needs of the paediatric patient in hospital, including the ever increasing need to take into account cultural differences. Hospital policy should include a preoperative preparation programme, specially aimed at the paediatric population, where parental involvement is encouraged throughout.

AIM Well know in USA, Australia and then in western European countries, day surgery is still at the beginning in Romania and eastern European countries. In this paper we want to analyze the evolution and actual situation of day surgery in Romania and in County Emergency Hospital Timisoara (CEHT). MATERIAL AND METHODS In the implementation of day surgery in our country there were two distinct periods. Between 2007- 2013 the CEHT negotiated its own day surgery baskets with Local Health Insurance Company (LHIC). Starting from 2014 until now, the National Health Insurance Company has established new day surgery baskets which can be negotiated between CEHT and LHIC. RESULTS Our study shows that day surgery in CEHT has had an undulating evolution - after a rising development at the beginning it stopped for a few years and now it has an ascendant evolution. DISCUSSION In this context, International Association for Ambulatory Surgery (IAAS) has initiated a series of actions to support imple...

Day-case surgery (DCS) has boomed over recent years, as has laparoscopic sleeve gastrectomy (SG) for the treatment of morbid obesity. The objective of this study was to evaluate the safety and feasibility of day-case SG. This was a prospective, nonrandomized study of 100 patients undergoing day-case SG from May 2011 to July 2013. All patients met the criteria for DCS and for the treatment of morbid obesity. Standard surgical, anesthetic, and analgesic protocols were used. The primary study endpoint was the unplanned overnight admission rate. Secondary endpoints were standard DCS criteria, frequency and type of complications, and satisfaction rate of performing day-case SG. The short-term postoperative course of patients undergoing day-case and conventional SG also were compared. A total of 416 patients were screened and 100 (24%) were included. There were 8 unplanned overnight admissions. Seven unexpected consultations, 7 hospital readmissions, and 5 major complications were recorde...

With the continued growth of ambulatory surgical centers (ASC), the regulation of facilities has evolved to include new standards and requirements on both state and federal levels. Accreditation allows for the assessment of clinical practice, improves accountability, and better ensures quality of care. In some states, ASC may choose to voluntarily apply for accreditation from a recognized organization, but in others it is mandated. Accreditation provides external validation of safe practices, benchmarking performance against other accredited facilities, and demonstrates to patients and payers the facility's commitment to continuous quality improvement.

Although Internet-based quality assurance and peer review data have demonstrated the safety of procedures performed in the outpatient setting through the analysis of outcomes, the future of patient care will be directed by evidence-based medicine. Large inpatient surgical databases have long existed to provide quality assurance and improvement data for the inpatient cohort of patients. The acquisition of large data sets related to surgical care can best be achieved through the Internet. When outcomes are analyzed in conjunction with the indications for a procedure and the manner that care was delivered, evidence-based medicine is the end product.

A series of 51 active duty patients who elected to undergo ambulatory surgery in a Navy Fleet Hospital Training Set (a modified field hospital) over a 2-year period were followed prospectively for perioperative complications. All patients were active duty personnel, ranging in grade from E1 to O5, who voluntarily gave specific informed consent to have their surgery performed in the training set. Patients were offered surgery in the training set only if attending surgeons were confident that the surgery could be done safely and with the same expected outcome as if performed in the hospital. Their entire surgical experience was contained within this tent-based field facility from admission to discharge. There were 12 orthopedic surgery, 4 general surgery, 3 otolaryngology, 2 urology, 1 ophthalmology, and 29 oral and maxillofacial surgery cases. General, regional, or local anesthesia or intravenous conscious sedation were used as indicated. No patients developed wound infections, and t...

Hemorrhoidectomy is the most effective long-term treatment for hemorrhoids, mostly done in an inpatient setting requiring general or spinal anesthesia. To assess the safety and early post-operative results of outpatient closed hemorrhoidectomy under perianal anesthetics infiltration. A retrospective study of outpatient closed hemorrhoidectomy under perianal block during March 2002 and May 2003 in an ambulatory facility of the Department of Surgery, Siriraj Hospital, Bangkok. Fifty-five patients with third-degree or fourth-degree internal hemorrhoids underwent outpatient closed hemorrhoidectomy under perianal block, including 40 males and 15 females. The mean age was 44.4 +/- 12.2 years (21-72 years). Sites of hemorrhoidectomy at each operation were single 53%, double 42% and triple 5%. Mean operative time was 20.7 +/- 9.9 minutes (5-60 minutes). Additional anal procedures were performed in 6 cases. Severity of early postoperative pain were mild in 35% of the patients, moderate in 40...

Office operative hysteroscopy is a recent technique that enables treatment of uterine pathologic disorders in the ambulatory setting using miniaturized hysteroscopes with mechanical or electric instruments. The available international literature from 1990 to 2002 has clearly demonstrated that such technique enables performance of hysteroscopically directed endometrial biopsy and treatment of uterine adhesions, anatomic disorders, polyps, and small myomas safely and successfully without cervical dilation and the need for anesthesia. This review provides a comprehensive survey of further advancements of office operative hysteroscopy in the treatment of other gynecologic pathologic conditions that have not been included in the schema of treatment indications for office procedures proposed in 2002. A search of MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews identified articles published from 2003 to 2009. Eighteen articles were identified: 9 on hysteroscopic sterilization; 1 on office-based metroplasty, 8 on office-based treatment of some uncommon gynecologic pathologic conditions (e.g., hematometra, diagnosis and treatment of vaginal lesions, treatment of uterine cystic neoformations, bleeding from the cervical stump, diagnosis and treatment of endocervical ossification, and removal of uterovaginal packing). All performed procedures were carried out safely and successfully in the office setting, with high patient tolerance and minimal discomfort. The success of the procedures has been confirmed by resolution of symptoms and at follow-up ultrasonographic and hysteroscopic examinations. Currently, as a result of technologic advancements and increased operator experience, an increasing number of gynecologic pathologic conditions traditionally treated in the operating room may be treated safely and effectively using office operative hysteroscopy.