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Fishley WG, Paice S, Iqbal H, Mowat S, Kalson NS, Reed M, Partington P, Petheram TG. Low readmission and reattendance rate in day-case total knee arthroplasties. Bone Jt Open 2023; 4:621-627. [PMID: 37604493 PMCID: PMC10442176 DOI: 10.1302/2633-1462.48.bjo-2023-0043.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Aims The rate of day-case total knee arthroplasty (TKA) in the UK is currently approximately 0.5%. Reducing length of stay allows orthopaedic providers to improve efficiency, increase operative throughput, and tackle the rising demand for joint arthroplasty surgery and the COVID-19-related backlog. Here, we report safe delivery of day-case TKA in an NHS trust via inpatient wards with no additional resources. Methods Day-case TKAs, defined as patients discharged on the same calendar day as surgery, were retrospectively reviewed with a minimum follow-up of six months. Analysis of hospital and primary care records was performed to determine readmission and reattendance rates. Telephone interviews were conducted to determine patient satisfaction. Results Since 2016, 301/7350 TKAs (4.1%) in 290 patients at our institution were discharged on the day of surgery. Mean follow-up was 31.4 months (6.2 to 70.0). In all, 28 patients (9.3%) attended the emergency department or other acute care settings within 90 days of surgery, most often with wound concerns or leg swelling; six patients (2.0%) were readmitted. No patients underwent a subsequent revision procedure, and there were no periprosthetic infections. Two patients (0.7%) underwent secondary patella resurfacing, and one patient underwent arthroscopic arthrolysis after previous manipulation under anaesthetic (MUA). Three patients (1.0%) underwent MUA alone. Primary care consultation records, available for 206 patients, showed 16 patients (7.8%) contacted their general practitioner within two weeks postoperatively; two (1.0%) were referred to secondary care. Overall, 115/121 patients (95%) telephoned stated they would have day-case TKA again. Conclusion Day-case TKA can be safely delivered in the NHS with no additional resources. We found low incidence of contact with primary and secondary care in the postoperative period, and high patient satisfaction.
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Affiliation(s)
- William G. Fishley
- Northumbria Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
- University of York, York, UK
| | - Sarah Paice
- Northumbria Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
| | - Haaris Iqbal
- Northumbria Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
| | - Stephen Mowat
- Northumbria Anaesthetics, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
| | - Nicholas S. Kalson
- Northumbria Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Mike Reed
- Northumbria Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
- University of York, York, UK
| | - Paul Partington
- Northumbria Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
| | - Timothy G. Petheram
- Northumbria Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
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2
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Byford S, Madhok D, Baldan P, Amey G, Barber J, Harris R, Walker G. Introduction of the day case total laparoscopic hysterectomy (TLH) protocol. Aust N Z J Obstet Gynaecol 2022; 62:881-886. [PMID: 35906724 DOI: 10.1111/ajo.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traditionally total laparoscopic hysterectomy (TLH) patients are admitted for 1-2 days post-operatively. Day case TLH has been proven to be feasible and safe in other countries; however, this tertiary Queensland hospital is one of the first Australian institutions to introduce a day case TLH protocol. AIM To pilot the implementation of our day case TLH protocol assessing the feasibility, safety and patient satisfaction of same-day discharge. MATERIALS AND METHODS A retrospective audit of the implementation of our day case TLH protocol at a tertiary Queensland hospital was conducted. Primary outcome was length of post-operative hospital stay. Secondary outcomes included perioperative complications and post-operative re-presentation rates. Patient satisfaction was assessed through a patient questionnaire. RESULTS Seventy-seven patients were included in the study. There were 94.81% patients who went home on the same day. Their average length of post-operative hospital stay was 7.72 (SD ± 3.36) hours. Of the patients who did achieve same-day discharge, the average length of stay was 7.05 (SD ±1.46) hours. There were no significant differences in perioperative complications or re-presentation rates compared to previously published literature. Patients reported they were extremely satisfied with day case TLH. CONCLUSION The implementation of our day case TLH protocol is feasible, safe and well received by patients in our tertiary Australian hospital. These results can have multimodal effects in healthcare: decrease in hospital costs by reducing length of stay and overnight admissions, improved theatre efficiency and patient flow, while maintaining patient safety and satisfaction.
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Affiliation(s)
- Sally Byford
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Drishti Madhok
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Paula Baldan
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Guy Amey
- Anesthetics, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - James Barber
- Obstetrics and Gynaecology, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Rhys Harris
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Graeme Walker
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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3
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Moffatt S, Garry C, McCann H, Teeling SP, Ward M, McNamara M. The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery. Int J Environ Res Public Health 2022; 19:1588. [PMID: 35162610 PMCID: PMC8835068 DOI: 10.3390/ijerph19031588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
Abstract
Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient's length of stay. This study contributes to the growing body of published evidence which shows that adopting a Lean Six Sigma approach can be successfully employed to optimise care and surgical pathways in healthcare.
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Affiliation(s)
- Sinead Moffatt
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Catherine Garry
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Hannah McCann
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, Dublin 2, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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4
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Campbell M, Ng D, Albatat B, Lowen D, Bird D, Hodgson R. Quality of recovery assessment of day case and multiday stay patients undergoing elective laparoscopic cholecystectomy. Turk J Surg 2021; 37:355-362. [PMID: 35677494 PMCID: PMC9130945 DOI: 10.47717/turkjsurg.2021.5451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022]
Abstract
Objectives Many laparoscopic cholecystectomy operations are performed with at least overnight admission. Current research shows that laparoscopic cholecystectomy is safe and feasible to do as a day case. Patient centred outcomes are less well understood. Material and Methods Elective laparoscopic cholecystectomy patients at a single metropolitan hospital in Melbourne, Australia were surveyed 24 hours after surgery using the 15-question Quality of Recovery (QoR-15) survey. A comparison was made between day case surgeries and multi-day surgeries. Results One hundred and eight patients were recruited consisting of 34 day case and 74 multi-day patients. Patient groups did not differ in terms of age, sex or postoperative morbidity. The multi-day group had a higher proportion of comorbid patients (p-value = 0.03). There was no significant dif- ference in overall QoR-15 score between the two groups, although there was an observed trend towards a higher score in the day case group (132.0 vs 127.9, p= 0.147). QoR-15 individual question results showed that day cases rated significantly better for sleep quality and for less feelings of anxiety or worry. The differences narrowed when comparing patient groups as they were booked (intention-to-treat). There were no identified sub-groups that had a significantly higher score if admitted multi-day. Conclusion Quality of recovery following day case laparoscopic cholecystectomy is just as good, if not better, than multi-day cases. Laparoscopic cholecystectomy as a day case is both safe and economically superior to multi-day management. This gives further weight to current recommendations suggesting that the majority of laparoscopic cholecystectomy operations could be performed as day cases.
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Affiliation(s)
- Matthew Campbell
- Clinic of General Surgery, Northern Health Hospital, Epping, Australia
| | - Daniel Ng
- Clinic of General Surgery, Northern Health Hospital, Epping, Australia
| | - Batool Albatat
- Clinic of General Surgery, Northern Health Hospital, Epping, Australia
| | - Darren Lowen
- Clinic of Anaesthetics, Northern Health Hospital, Epping, Australia
| | - David Bird
- Clinic of General Surgery, Northern Health Hospital, Epping, Australia
| | - Russell Hodgson
- Clinic of General Surgery, Northern Health Hospital, Epping, Australia
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5
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Palumbo P, Massimi F, Biondi A, Cirocchi R, De Luca GM, Giraudo G, Intini SG, Monzani R, Sozio G, Usai S. Recommendations for outpatient activity in COVID-19 pandemic. Open Med (Wars) 2021; 16:1696-1704. [PMID: 34805532 PMCID: PMC8578809 DOI: 10.1515/med-2021-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/23/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
The spread of the COVID-19 disease substantially influenced the International Healthcare system, and the national governments worldwide had before long to decide how to manage the available resources, giving priority to the treatment of the COVID-infected patients. Then, in many countries, it was decided to limit the elective procedures to surgical oncology and emergency procedures. In fact, most of the routine, middle-low complexity surgical interventions were reduced, and the day surgery (DS) activities were almost totally interrupted. As a result of this approach, the waiting list of these patients has significantly increased. In the current phase, with a significant decrease in the incidence of COVID-19 cases, the surgical daily activity can be safely and effectively restarted. Adjustments are mandatory to resume the DS activity. The whole separation of pathways with respect to the long-stay and emergency surgery, an accurate preoperative protocol of patient management, with a proper selection and screening of all-day cases, careful scheduling of surgical organization in the operating room, and planning of the postoperative pathway are the goals for a feasible, safe, and effective resumption of DS activity.
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Affiliation(s)
- Piergaspare Palumbo
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Fanny Massimi
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Antonio Biondi
- Department of General Surgery and Surgical Specialities, University of Catania, Catania, Italy
| | - Roberto Cirocchi
- Deparment of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Giorgio Giraudo
- Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | - Roberta Monzani
- Department of Anesthesia and Intensive Care, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giampaolo Sozio
- Department of General Surgery and Emergency, Alta Val D’Elsa Hospital, Poggibonsi (SI), Italy
| | - Sofia Usai
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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6
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Harrison C, Remoundos DD, Harvey KL, Stoker GV, MacLean G, Adwani A, Roy PG. Increasing the incidence of drain-free day-case mastectomies with the use of a fibrin tissue sealant; data from a single surgical center in the United Kingdom. Breast J 2019; 25:1090-1096. [PMID: 31338929 DOI: 10.1111/tbj.13419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
Day-case mastectomy surgery provides benefits to both patients and hospitals. Key barriers are the use of a drain and the risk of postoperative seroma formation. We introduced the use of a tissue sealant (Artiss) into the surgical site (post-mastectomy without immediate reconstruction and postaxillary clearance) and evaluated its effect on our practice, particularly day-case rates. A prospective audit of 177 patients who underwent a simple mastectomy with or without axillary surgery, or axillary node clearance with or without breast-conserving surgery was conducted at a single surgical center in the UK between November 2015 and November 2016. Artiss was used in all operations and, where appropriate, the drain was omitted to facilitate day-case surgery. The clinical outcomes were compared between patients undergoing different operations and duration of hospital stay. There was no statistically significant difference between day-case patients and inpatients in seroma aspiration rates (24.5% and 21.7%, respectively; P = 0.381) or other complications (22.4% and 16.1%, respectively; P = 0.106). The day-case mastectomy rate increased from 3.9% in the first quarter to 45.5% in the final quarter, which was a significant increase reaching well beyond the national target. The use of Artiss enabled us to increase the drain-free day-case surgery rates over a 1-year period, exceeding the 30% target recommended by the British Association of Day Surgery. We did not observe any increase in patient morbidity, and the change was cost-effective. We have now implemented the routine use of Artiss in women undergoing simple mastectomy with or without axillary surgery and stand-alone axillary node clearances as part of enhanced recovery clinical pathways.
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Affiliation(s)
- Conrad Harrison
- Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Medical Sciences Office, University of Oxford, Oxford, UK
| | - Dionysios D Remoundos
- Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate L Harvey
- Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gill V Stoker
- Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gael MacLean
- Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Asha Adwani
- Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pankaj G Roy
- Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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7
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Merinopoulos I, Wickramarachchi U, Wardley J, Khanna V, Gunawardena T, Maart C, Vassiliou VS, Eccleshall SC. Day case discharge of patients treated with drug coated balloon only angioplasty for de novo coronary artery disease: A single center experience. Catheter Cardiovasc Interv 2019; 95:105-108. [PMID: 30957384 DOI: 10.1002/ccd.28217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/23/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To report our initial experience with drug coated balloon (DCB) only angioplasty and propose a protocol to achieve this safely. BACKGROUND There are no articles published in the literature currently regarding the safety of same day discharge in patients treated with DCB-only angioplasty. METHODS Retrospective review of all our patients treated with DCB-only angioplasty from September 2017 to April 2018 with identification of potential complications relating to same day discharge. RESULTS A total of 100 consecutive patients who underwent elective DCB-only angioplasty for de novo coronary artery disease and were discharged on the same day as the procedure were included. In 99% no cardiac symptoms relating to the procedure requiring urgent hospitalization or urgent investigations were identified. One patient was readmitted the next day requiring stenting of the previously treated lesion. Our 30-day mortality was zero. Some 97 hospital bed days were saved with 100 patients treated. CONCLUSION Elective day-case DCB-only angioplasty according to our local protocol is safe and cost-effective and should be considered for the majority of the patients.
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Affiliation(s)
- Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK.,Cardiovascular Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Upul Wickramarachchi
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK.,Cardiovascular Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - James Wardley
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Vikram Khanna
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tharusha Gunawardena
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK.,Cardiovascular Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Clint Maart
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK.,Cardiovascular Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.,Cardiovascular Medicine, Royal Brompton Hospital and Imperial College, London, UK
| | - Simon C Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
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8
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Davies LA, Crawford EMS, Jones JL, Jones SD. Day-case bilateral sagittal split osteotomy. Br J Oral Maxillofac Surg 2018; 56:968-971. [PMID: 30528366 DOI: 10.1016/j.bjoms.2018.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 09/27/2018] [Indexed: 10/27/2022]
Abstract
In the UK, patients who have bilateral sagittal split osteotomy (BSSO) have generally been thought to require inpatient admission and an overnight hospital stay. However, since the introduction of national standards on day case surgery in the UK in 2011, patients at the Royal Gwent Hospital, Newport, have been treated as day cases, and have been pleased with the results. The aim of this paper was to show that these procedures conform to current national standards, and can be done successfully and safely. We retrospectively reviewed all patients who had isolated BSSO planned as day cases between March 2015 and February 2017. Thirty-four were eligible. Of them, 32 were discharged on the day of operation and two were admitted postoperatively: one because of severe nausea and vomiting and the other because of bleeding. No patients were readmitted within 48hours of the procedure. BSSO can be done successfully and routinely as a day-case procedure. However, to reduce the rate of unplanned admissions, we recommended that operations start early in the morning.
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Affiliation(s)
- L A Davies
- Oral and Maxillofacial Surgery Department, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, United Kingdom.
| | - E M S Crawford
- Oral and Maxillofacial Surgery Department, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, United Kingdom.
| | - J L Jones
- Oral and Maxillofacial Surgery Department, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, United Kingdom.
| | - S D Jones
- Oral and Maxillofacial Surgery Department, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, United Kingdom.
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9
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Coughlan JJ, Zebrauskaite A, Arnous S, Kiernan TJ. Left distal trans-radial access facilitates earlier discharge post-coronary angiography. J Interv Cardiol 2018; 31:964-968. [PMID: 30187577 DOI: 10.1111/joic.12559] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 12/27/2022] Open
Abstract
AIMS In 2017, Kiemeneij published a paper on distal trans-radial artery access for coronary angiography in 62 patients. This paper proposed several advantages to this method. Since this paper was published, several other papers have been published describing this technique, with less than 200 cases in total described. We performed a non randomized control study of left distal trans-radial access in patients undergoing coronary angiography in our center. METHODS We prospectively identified patients presenting for coronary angiography to our center for enrolment in this study. We recruited 94 patients (47 ldTRA, 47 age and sex matched controls). Pre-defined endpoints for the study were as follows: time until radial compression device (RCD) removal, procedural time, radiation dose, fluoroscopy time, and contrast dose. RESULTS Patient and procedural characteristics did not differ significantly between the two groups. With regard to our primary endpoint, patients undergoing ldTRA required, on average, 69 min less time until removal of the RCD (167.8 ± 30 vs 236.6 ± 63.9 min, P < 0.0001). Procedural length did not vary between groups (28.95 ± 5.89 vs 29.76 ± 8.16 min, P = 0.5824). Similarly, there was no statistically significant difference in radiation dose area product (5032.66 ± 2740 vs 4826 ± 2796 Gy/cm2 , P = 0.7191), contrast dose (82.93 ± 23 vs 92.1 ± 33 mL, P = 0.1215), and fluoroscopy time between the two groups (5.41 ± 3.42 vs 4.82 ± 2.97 min, P = 0.3742). CONCLUSIONS Our study confirms that ldTRA is a feasible technique for diagnostic coronary angiography in a modern cardiac catheterization laboratory. It results in decreased post-procedure radial artery compression time without increasing procedural time or radiation dose.
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Affiliation(s)
| | - Aiste Zebrauskaite
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Samer Arnous
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Thomas J Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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10
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Adebayo SA, Chibuzo INC, Takure AO, Ifeh MO, Olapade‐Olaopa EO, Okeke LI, Shittu OB. Urethral steinstrasse: Day case care. Clin Case Rep 2018; 6:1697-1700. [PMID: 30214744 PMCID: PMC6132097 DOI: 10.1002/ccr3.1703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/03/2018] [Accepted: 06/12/2018] [Indexed: 11/17/2022] Open
Abstract
Urethral steinstrasse is rare. Only a few cases of spontaneous or postinterventional urethral steinstrasse have been reported in pediatric and adult patients. We report a case of a 52-year-old Nigerian man with a secondary urethral steinstrasse, and the treatment options possible, as day case procedures, under caudal anesthesia.
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Affiliation(s)
- Sikiru A. Adebayo
- Department of SurgeryUniversity College Hospital IbadanIbadanOyo StateNigeria
- College of MedicineUniversity of IbadanIbadanOyo StateNigeria
- Present address:
King Khaled Hospital5131 King Abdul‐Aziz Road, Al‐KhalediyaNajran61441Saudi Arabia
| | | | - Augustine O. Takure
- Department of SurgeryUniversity College Hospital IbadanIbadanOyo StateNigeria
- College of MedicineUniversity of IbadanIbadanOyo StateNigeria
| | - Marcus O. Ifeh
- Department of SurgeryUniversity College Hospital IbadanIbadanOyo StateNigeria
| | - E. Oluwabunmi Olapade‐Olaopa
- Department of SurgeryUniversity College Hospital IbadanIbadanOyo StateNigeria
- College of MedicineUniversity of IbadanIbadanOyo StateNigeria
| | - Linus I. Okeke
- Department of SurgeryUniversity College Hospital IbadanIbadanOyo StateNigeria
- College of MedicineUniversity of IbadanIbadanOyo StateNigeria
| | - Olayiwola B. Shittu
- Department of SurgeryUniversity College Hospital IbadanIbadanOyo StateNigeria
- College of MedicineUniversity of IbadanIbadanOyo StateNigeria
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11
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Padhy N, Mohapatra DP, Meethale Thiruvoth F, Chittoria RK, Kumar Shivakumar D, Kumar SH, Subbarayan E. The triangular rotation advancement flap for congenital longitudinal earlobe cleft. Clin Otolaryngol 2017; 43:986-988. [PMID: 29045031 DOI: 10.1111/coa.13007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- N Padhy
- Department of Anatomy, MKCG Medical College, Berhampur, India
| | - D P Mohapatra
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - F Meethale Thiruvoth
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - R K Chittoria
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - D Kumar Shivakumar
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - S H Kumar
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - E Subbarayan
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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12
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Abstract
PURPOSE Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction. RECENT FINDINGS This review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED) and emergence agitation (EA). New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed. SUMMARY Long-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6-4-0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up.
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Affiliation(s)
- Hal Robinson
- Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Thomas Engelhardt
- Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK
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13
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Abstract
Thyroidectomy has been performed on an inpatient basis because of concerns regarding postoperative complications. These include cervical hematoma, bilateral recurrent laryngeal nerve injury and symptomatic hypocalcemia. We have reviewed the current available evidence and aimed to collate published data to generate incidence of the important complications. We performed a literature search of Medline, EMBASE and the Cochrane database of randomized trials. One hundred sixty papers were included. Twenty-one papers fulfilled inclusion criteria. Thirty thousand four hundred fifty-three day-case thyroid procedures were included. Ten papers were prospective and 11 retrospective. The incidences of complications were permanent vocal cord paralysis 7/30259 (0.02%), temporary hypocalcemia 129/4444 (2.9%), permanent hypocalcemia 405/29203 (1.39%), cervical hematoma 145/30288 (0.48%) and readmission rate 105/29609 (0.35%). Analysis of cervical hematoma data demonstrated that in only 3/14 cases the hematoma presented as an inpatient, and in the remaining 11/14, it occurred late, with a range of 2–9 days. There is a paucity of data relating to anesthetic techniques associated with ambulatory thyroidectomy. Cost comparison between outpatient and inpatient thyroidectomy was reported in three papers. Cost difference ranged from $676 to $2474 with a mean saving of $1301 with ambulatory thyroidectomy. There is a body of evidence that suggests that ambulatory thyroidectomy in the hands of experienced operating teams within an appropriate setting can be performed with acceptable risk profile. In most circumstances, this will be limited to hemithyroidectomies to reduce or avoid the potential for additional morbidity. We have found little evidence to support the use of one anesthetic technique over another. The rates of hospital admission and readmission related to anesthetic factors appear to be low and predominantly related to pain and postoperative nausea and vomiting. A balanced anesthetic technique incorporating appropriate analgesic and antiemetic regimens is essential to avoid unnecessary hospital admission/readmission.
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Affiliation(s)
| | - Sankalap Tandon
- Department of Otolaryngology, Head & Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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14
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Abstract
AIM The aim of this paper is to study the outcome of day case laparoscopic cholecystectomy (DCLC) in children. MATERIALS AND METHODS A clinical pathway for day care laparoscopic cholecystectomy was followed with emphasis on the analgesia, post-operative nausea and vomiting (PONV), feeding, mobilization, pain scoring and patient satisfaction. Demographic and clinical data were recorded prospectively from March 2013 to November 2013. The setup allowed easy access to an overnight stay if needed. Hospital stay, complications, the need for medical advice after discharge, convalescence and patients satisfaction were analyzed. RESULTS We admitted 11 children with symptomatic cholelithiasis for day case laparoscopic surgery. There were no intra- or post-operative complications. The incidence of PONV was 0/11. There was no readmission. 4/11 patients complained of shoulder tip pain on follow-up next day. There was no overnight stay. CONCLUSIONS Adoption of a DCLC pathway is feasible and safe for children. Emphasis on adequate pain management and avoidance of PONV results in a high rate of day case surgery equivalent to that achieved in adult practice.
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Affiliation(s)
- Prakash Agarwal
- Department of Pediatric Surgery, Apollo Children's Hospital, Chennai, Tamil Nadu, India
| | - Raj Kishore Bagdi
- Department of Pediatric Surgery, Apollo Children's Hospital, Chennai, Tamil Nadu, India
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15
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Norrington AC, Flood LM, Meek T, Tremlett MR. Does day case pediatric tonsillectomy increase postoperative pain compared to overnight stay pediatric tonsillectomy? A prospective comparative audit. Paediatr Anaesth 2013; 23:697-701. [PMID: 23710891 DOI: 10.1111/pan.12201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical and financial pressures in the United Kingdom's National Health Service have been a stimulus for change from overnight stay to day case surgery for many procedures, including pediatric tonsillectomy. There are no prospective studies to assess whether such a change in practice alters children's experiences of pain and perioperative morbidity. Therefore, we undertook a prospective audit to measure these adverse outcomes during this change of practice in our unit. METHODS Sixty children aged between 3 and 15 years who required tonsillectomy were recruited to this prospective comparative audit. Children received treatment on either an overnight stay (n = 28) or day case (n = 32) basis following a strict perioperative care pathway. The primary endpoints were the pain scores reported using a visual analogue scale, and secondary endpoints were vomiting, consultation with healthcare providers, readmission and patient satisfaction. Outcome data were collected from parents at 24 h and 7 days. RESULTS There was a small, but significant, risk of greater baseline pain scores in the day case surgery group during the first 24 h. However, there was no difference in the worst pain experienced during the first 24 h, or any pain experienced at 7 days. There was no difference in any of the secondary outcome measures between the groups. CONCLUSIONS Change in practice from overnight stay to day case surgery for pediatric tonsillectomy requires careful consideration of how to extend effective analgesia for this painful procedure into the home.
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Affiliation(s)
- Amy C Norrington
- Department of Anaesthesia, The James Cook University Hospital, Middlesbrough, UK
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16
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Abstract
INTRODUCTION Over the last two decades increasing numbers of surgical procedures have been performed on an outpatient basis. In 2000 the National Health Service in England set the target of performing 75% or more of all elective surgical procedures as day cases and in 2001 the British Association of Day Surgery added thyroidectomy to the list of day case procedures. However, same day discharge following thyroidectomies has been adopted by only a very small number of UK centres. The aim of this review was to establish the evidence base surrounding same day discharge thyroid surgery. METHODS The British Association of Endocrine and Thyroid Surgeons commissioned the authors to perform a review of the best available evidence regarding day case thyroid surgery as a part of a consensus position to be adopted by the organisation. A MEDLINE(®)review of the English medical literature was performed and the relevant articles were collated and reviewed. RESULTS There are limited comparative data on day case thyroid surgery. It is feasible and may save individual hospitals the cost of inpatient stay. However, the risk of airway compromising and life threatening post-operative bleeding remains a major concern since it is not possible to positively identify those patients most and least at risk of bleeding after thyroidectomy. It is estimated that half of all post-thyroidectomy bleeds would occur outside of the hospital environment if patients were discharged six hours after surgery. CONCLUSIONS Same day discharge in a UK setting cannot be endorsed. Any financial benefits may be outweighed by the exposure of patients to an increased risk of an adverse outcome. Consequently, 23-hour surgery is recommended.
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Affiliation(s)
- HE Doran
- on behalf of the British Association of Endocrine and Thyroid Surgeons
| | - J England
- on behalf of the British Association of Endocrine and Thyroid Surgeons
| | - F Palazzo
- on behalf of the British Association of Endocrine and Thyroid Surgeons
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17
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Abstract
Ambulatory emergency care (AEC), ie managing emergency patients without an overnight hospital stay, offers an alternative to routine hospital admission and improved patient experience. The Directory of ambulatory emergency care for adults identifies 49 clinical scenarios which present acutely but could potentially be managed in an ambulatory manner. The Society for Acute Medicine and the NHS Institute for Innovation and Improvement conducted a national survey of 131 UK acute hospitals to understand the current level of AEC provision. Seventy-nine per cent of respondents indicated their site provided some AEC, but the number of conditions covered was limited and AEC tended to be ad hoc and informal at most sites. Weekend access was limited. Only deep vein thrombosis ambulatory protocols were well-established (65%), with other conditions formally implemented as ambulatory pathways at 0-35% of responding sites. There is a significant opportunity for further expansion of AEC through increased awareness and support.
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