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المؤلفون: Kristin Gee, Sandra Ngo, Lorrie S. Burkhalter, Alana L. Beres
المصدر: Journal of pediatric surgery. 53(5)
مصطلحات موضوعية: Male, medicine.medical_specialty, Adolescent, Nausea, 03 medical and health sciences, 0302 clinical medicine, medicine, Appendectomy, Humans, Surgical emergency, Prospective Studies, Prospective cohort study, Child, Same day discharge, business.industry, General surgery, General Medicine, Evidence-based medicine, Ambulatory Surgical Procedure, medicine.disease, Appendicitis, Patient Discharge, Treatment Outcome, Ambulatory Surgical Procedures, 030220 oncology & carcinogenesis, Child, Preschool, Pediatrics, Perinatology and Child Health, Vomiting, Feasibility Studies, 030211 gastroenterology & hepatology, Surgery, Female, Laparoscopy, Patient Safety, medicine.symptom, business, Follow-Up Studies
الوصف: Background Appendicitis is the most common gastrointestinal pediatric surgical emergency. With the introduction of laparoscopic techniques in the 1990s, recovery, pain, and hospital stay after laparoscopic procedures have been significantly reduced. While many laparoscopic procedures are performed as outpatient surgeries, pediatric appendectomy patients continue to be hospitalized for postoperative observation. Our goal was to evaluate the safety and feasibility of same day discharge after laparoscopic appendectomy for uncomplicated appendicitis. Methods After IRB approval, all pediatric patients undergoing laparoscopic appendectomy during 2016 for noncomplicated appendicitis were eligible for the study. Decision for same day discharge was based on surgeon preference and parental agreement. Data regarding demographics, admission and discharge times, outcomes of complications, readmissions, return to the ED, and nonscheduled clinic visits were collected. Results A total of 1321 appendectomies were performed during the study period, of which 849 were uncomplicated and 382 were discharged same day. There were 2 readmissions, 4 superficial surgical site infections, 10 patients with nausea or vomiting, and 33 patients with pain control issues, 9 of whom presented to the ED. Conclusions Same day discharge for laparoscopic noncomplicated appendectomy is a safe and feasible alternative to postoperative admission and observation. This has the potential to yield significant healthcare cost savings. Level of Evidence Level II, Prospective Cohort Study.
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المؤلفون: De'Ana Singletary
المصدر: Nursing management (Harrow, London, England : 1994). 23(4)
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Leadership and Management, Outpatient surgery, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, Humans, Same day discharge, business.industry, Surgical procedures, medicine.disease, Patient Discharge, United States, Treatment Outcome, Ambulatory Surgical Procedures, Preparedness, Hospital admission, Emergency medicine, Ambulatory, Practice Guidelines as Topic, 030211 gastroenterology & hepatology, Female, Medical emergency, Patient Safety, business, Service development
الوصف: In the US, safe and effective same-day discharge of patients, following uncomplicated, ambulatory surgery, also referred to as outpatient surgery, significantly reduces the nursing hours spent caring for patients who do not require hospital admission. Data from the last three decades show that same-day discharge for patients who undergo approved outpatient surgical procedures carries no higher risk of complications than for those who stay for 24-hour observation. This article describes a service development project which evaluated patients' perceived preparedness for same-day discharge. Results suggest that a standardised approach to managing potential complicating factors, such as pain and patients' expectations, can increase the number of successful same-day discharges. The terms outpatient and ambulatory are used interchangeably in the article, and refer to surgical procedures for which inpatient admission is not considered necessary by patients' insurance providers.
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