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Dreuning KM, Derikx JP, Ouali A, Janssen LM, Tulder MWV, Twisk JW, Haverman L, van Heurn LE. One-Stop Surgery: An Innovation to Limit Hospital Visits in Children. Eur J Pediatr Surg 2021; 32:435-442. [PMID: 34856625 PMCID: PMC9481276 DOI: 10.1055/s-0041-1740158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION One-stop surgery (OSS) allows for same-day outpatient clinic visit, preoperative assessment, and surgical repair. This study aims to determine the efficiency, (cost-)effectiveness, and family satisfaction of one-stop inguinal hernia surgery compared with usual care. MATERIAL AND METHODS Children (≥ 3 months) with inguinal hernia and American Society of Anesthesiologists (ASA) grades I-II, scheduled for OSS (intervention) or regular treatment (control) between March 1, 2017, and December 1, 2018, were eligible for inclusion. Exclusion criteria consisted of age less than 3 months and ASA grades III-IV. The primary outcome measure was treatment efficiency (i.e., total number of hospital visits and waiting time [days] between referral and surgery). Secondary outcome measures were the effectiveness in terms of complication and recurrence rate, and parent-reported satisfaction and cost-effectiveness using the Dutch Pediatric Quality of Life Healthcare Satisfaction and Institute for Medical Technology Assessment Productivity Cost Questionnaire. RESULTS Ninety-one (intervention: 54; control: 37) patients (56% boys) were included. Median (interquartile range) number of hospital visits was lower in the intervention group (1 vs 3; p < 0.001). All but one of the OSS patients (98%) were discharged home on the day of surgery. Postoperative complication (1.9% vs 2.7%; p = 0.787) and recurrence rates (0% vs 2.7%; p = 0.407) did not differ between the intervention and control patients. "General satisfaction," "satisfaction with communication," and "inclusion of family" were higher after OSS, while satisfaction about "information," "technical skills," and "emotional needs" were similar. Median (range) follow-up was 28 (15-36) months. CONCLUSIONS Pediatric one-stop inguinal hernia repair seems to be an effective treatment strategy that limits the number of hospital visits and provides enhanced family satisfaction without compromising the quality of care.
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Affiliation(s)
- Kelly M.A. Dreuning
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands,Address for correspondence Kelly M.A. Dreuning, MD Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit AmsterdamP.O. Box 22660, 1100 DD Amsterdamthe Netherlands
| | - Joep P.M. Derikx
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ayoub Ouali
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands,Department of Medical Informatics, University of Amsterdam, Amsterdam, the Netherlands
| | - Liedewij M.J. Janssen
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maurits W. van Tulder
- Department of Health Sciences, Amsterdam Movement Science Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jos W.R. Twisk
- Department of Methodology and Applied Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L.W. Ernest van Heurn
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Billings KR, Hajduk J, Thompson DM. Single Visit Evaluation and Tympanostomy Tube Placement for the Treatment of Acute Otitis Media in Children. Laryngoscope 2021; 131:2823-2829. [PMID: 34213781 DOI: 10.1002/lary.29714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/25/2021] [Accepted: 06/22/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To review our experiences with development of a single visit surgery (SVS) program for children with recurrent acute otitis media (AOM) undergoing tympanostomy tube (TT) placement the same day as their otolaryngology surgical consultation. STUDY DESIGN Retrospective cohort analysis. METHODS Retrospective series of patients participating in SVS from inception March 1, 2014 to April 30, 2020 were analyzed, with attention to factors associated with increasing interest and participation in SVS and parent experiences/satisfaction. RESULTS A total of 224 children had TT placed through SVS for AOM management. The average age of patients was 18.1 months (standard deviation 7.8 months), and 130 (58.0%) were male. The median interval between initial contact to schedule SVS, and the SVS date was 15 days (interquartile range 9-23 days). When analyzing year-over-year volumes from inception of SVS, notable increases were seen in 2016 and 2017 after a radio advertisement was played locally. A marked increase in volume was noted after implementation of a Decision Tree Scheduling (DTS) algorithm for children with recurrent AOM. Sixty-six (28.8%) procedures were performed after institution of DTS. A parent survey demonstrated high levels of satisfaction with the SVS experience. Estimations of savings to families in terms of time away from work demonstrated potential for indirect healthcare benefits. CONCLUSIONS SVS for TT placement was a successful, alternative model of care for management of children with AOM. Marketing strategies regarding SVS, and the inclusion of SVS pathway in DTS platforms increased rates of interest and choice of this option. Parents of children undergoing TT through SVS were satisfied with the overall experience. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Kathleen R Billings
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - John Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Dana M Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
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Aleksandrovich YS, Rybianov VV, Pshenisnov KV, Razumov SA. Perioperative complications of pediatric otorhinolaryngological operations. Saudi J Anaesth 2020; 14:446-453. [PMID: 33447185 PMCID: PMC7796726 DOI: 10.4103/sja.sja_99_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The identification of risk factors for the development of perioperative complications is one of the most important problems of pediatric anesthesiology. PURPOSE To identify risk factors for the development of perioperative complications in children undergoing ambulatory surgical interventions on ENT organs. METHODS Total of 141 patients were examined at the age from 7 to 17 years. Depending on the presence of complications all patients were divided into three groups: «No complications» (n = 64), «One complication» (n = 55) and «Two or more complications» (n = 22). The study was carried out in the following areas: Preoperative clinical status, intraoperative and postoperative complications. The severity of nasal breathing disorders was determined rhinomanometrically. 31 children underwent somnography. In the study of heart rate variability was evaluated. Intraoperative complications included: Cardiac arrhythmias, arterial hypertension and desaturation less than 90%. Postoperative complications included: Cardiorespiratory complications, pain, delirium, postoperative nausea and vomiting. RESULTS The most significant complication in the intraoperative period is desaturation below 90%, in the postoperative period they are pain, nausea and vomiting. Risk factors for the development of complications in the perioperative period are a decrease in the thyromental distance, hyperplasia of the tonsils of the third degree, Malampati score ≥ to 2 points, parents' bad habits, combined neurological and respiratory pathologies in a child, an assessment of the class «allergology» of the ASPOND scale is not less than 180 points and the prevalence of vagal influences. CONCLUSIONS The obtained results indicate that the presence of risk factors for perioperative complications during operations on ENT organs in children are associated with the initial autonomic status and the predominance of the parasympathetic nervous system as well as with clinical markers.
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Affiliation(s)
- Yu. S. Aleksandrovich
- Department of Anesthesiology, Intensive Care and Emergency Pediatrics, Postgraduate Education, St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - V. V. Rybianov
- Department of Anesthesiology, Intensive Care and Emergency Pediatrics, Postgraduate Education, St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - K. V. Pshenisnov
- Department of Anesthesiology, Intensive Care and Emergency Pediatrics, Postgraduate Education, St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - S. A. Razumov
- Department of Anesthesiology, Intensive Care and Emergency Pediatrics, Postgraduate Education, St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
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