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Ribeiro LM, Cosme FADEO, Lara PHS, Pochini ADEC, Ejnisman B, Belangero PS. ASSESSMENT OF THE LEVEL OF SATISFACTION OF PATIENTS SUBMITTED TO LATARJET SURGERY UNDER OUTFIT SYSTEM COMPARED TO HOSPITAL SYSTEM. Acta Ortop Bras 2023; 31:e264837. [PMID: 37876869 PMCID: PMC10592333 DOI: 10.1590/1413-785220233105e264837] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/19/2022] [Indexed: 10/26/2023]
Abstract
Anterior shoulder instability causes functional changes that affect patients' quality of life. The Latarjet procedure is one of the most frequently performed surgeries for cases of recurrent shoulder instability. Objective To assess the level of satisfaction of patients who underwent the Latarjet procedure in outpatient settings (day hospital) compared with inpatient settings. Methods A questionnaire was administered to both groups and a descriptive analysis of the results was performed. Results 51 patients were included, with a mean age of 29.9 years, 82.3% men and 17.6% women. Of the patients who underwent surgery in the day hospital, 46.1% were operated within 100 days of their first outpatient visit; among those in the inpatient group, 76.3% underwent surgery more than 200 days later. Delays occurred in 15.3% of cases in the day hospital compared with 68.4% in the inpatient group. Of the patients in the day hospital, 92.3% felt comfortable contacting the medical team in case of complications and would perform the procedure again in the same setting. Moreover, 63.2% of inpatients would have preferred to have been discharged on the same day. The final satisfaction rate for both groups was 100%. Conclusion Outpatient surgery guarantees more patient comfort, safety, and can be performed in a timely manner and with fewer delays, which has influenced patients' decision to have surgery during the COVID-19 pandemic. Level of Evidence V, Cross-sectional Study.
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Affiliation(s)
- Leandro Masini Ribeiro
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Fillipe Agra DE Oliveira Cosme
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Paulo Henrique Schmidt Lara
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Alberto DE Castro Pochini
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Paulo Santoro Belangero
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
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Álvarez-Aguilera M, DeJesús-Gil Á, Sánchez-Arteaga A, Tinoco-González J, Suárez-Grau JM, Tallón-Aguilar L, Padillo-Ruiz J. Implementing an outpatient surgical management in moderated-high risk patients with groin hernia repair. Hernia 2023; 27:1307-1313. [PMID: 37261641 DOI: 10.1007/s10029-023-02813-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE There is a growing trend to expand Ambulatory Surgery (AS) criteria in abdominal wall surgery. No Admission (NOADS) circuit. The present study aimed to assess the impact of classification criteria on postoperative results and hospital stays in a NOADS versus a conventional admission circuit to throw some light on surgical circuit inclusion. METHODS A retrospective analysis of a prospective;y maintained database was performed comparing groin hernia's interventions in a NOADS vs Admission circuit in our center in 2018-2021. A multiple regression predictive model followed by a retrospective retest were dessigned to assess the impact of each criterion on hospital stay. In total, 743 patients were included, 399 in the Admission circuit (ADC) and 344 in NOADS circuit (NOADS). RESULTS There were no statistical differences in complication or readmission rates (p = 0.343 and p = 0.563), nevertheless, a shorter hospital stay was observed in NOADS (p = 0.000). A hierarchical multiple regression predictive model proposed two opposite scenarios. The best scenario, not likely to need admission, was a female patient operated via the laparoscopic approach of a unilateral primary hernia (Estimated Postoperative Stay: 0.049 days). The worst scenario, likely to need admission, was a male patient operated via the open approach of a bilateral and recurrent hernia (Estimated Postoperative Stay: 1.505 Days). CONCLUSION Groin hernia patients could safely benefit from a No Admission (NOADS) circuit. Our model could be useful for surgical circuit decision-making, especially for best/worst scenarios.
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Affiliation(s)
- M Álvarez-Aguilera
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - Á DeJesús-Gil
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - A Sánchez-Arteaga
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - J Tinoco-González
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - J M Suárez-Grau
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - L Tallón-Aguilar
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain.
| | - J Padillo-Ruiz
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
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Núñez Díaz S, Espinilla Yagüe C, Mahtani Mahtani V. [Proposal for a new information model about the surgical waiting list.]. Rev Esp Salud Publica 2022; 96:perspectiva26_nunez_espinilla_mahtani. [PMID: 36128838] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023] Open
Abstract
In these moments in which the pandemic seems to have granted a truce, hospitals are beginning to normalize their care activity and data on waiting lists have begun to regain their prominence as they are the object of attention by all interest groups: citizens, the media, politicians and health professionals themselves. An improvement is proposed in the treatment of the information on the surgical waiting list that is usually published based on the analysis of some relevant indicators of it. This proposal can contribute to a better understanding and interpretation of waiting list data at such an important time as the present.
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Affiliation(s)
- Salvador Núñez Díaz
- Servicio de Gestión de la Demanda Asistencial, Dirección General de Programas Asistenciales del Servicio Canario de la Salud. Santa Cruz de Tenerife. España
| | - Carlos Espinilla Yagüe
- Servicio de Gestión de la Demanda Asistencial, Dirección General de Programas Asistenciales del Servicio Canario de la Salud. Santa Cruz de Tenerife. España
| | - Vijay Mahtani Mahtani
- Servicio de Gestión de la Demanda Asistencial, Dirección General de Programas Asistenciales del Servicio Canario de la Salud. Santa Cruz de Tenerife. España
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Mavroudis CL, Tong J, Wirtalla C, Brooks ES, Morris JB, Aarons CB, Kelz RR. (Re)thinking the Residential in Residency: Modern Surgical Practice Continues to Move Away From the Inpatient Setting. J Surg Educ 2021; 78:1250-1255. [PMID: 33358760 DOI: 10.1016/j.jsurg.2020.12.005] [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] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/16/2020] [Accepted: 12/05/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE Despite the overall shift in care delivery to an ambulatory setting, the majority of general surgical education still relies on the experience of caring for inpatients. We aimed to investigate how the inpatient practice patterns of newly minted general surgeons (GS) have changed since 2008, in order to better inform education policies regarding both training approach and setting for modern surgical trainees. METHODS State discharge data from NY and FL (2008-2017) were linked to data on GS from the American Medical Association Masterfile, and to hospital data from the American Hospital Association annual survey. Mean annual inpatient case volume (CV) and case type breadth (CB) were compared between surgeons who were new-to-practice (0-3 years of experience) in 2008 and in 2013. Each new surgeon cohort was followed for 5 years. Case type was classified by organ system. RESULTS The 2008 cohort included 328 GS with a mean age of 37.1, 79.6% male and 94.2% board-certified. The 2013 cohort included 359 GS with a mean age of 36.2, 73.0% male and 93.9% board-certified. CV was higher among the 2008 cohort than the 2013 cohort for each year of practice in the study period. CB included at least 4 organ system types for all new GS with greater breadth among the 2008 cohort for each year in the study period. CONCLUSIONS Declining rates of inpatient surgery affect general surgeons who were new-to-practice in 2013 significantly more than those entering practice only 5 years ahead of them. New surgeons continue to start their practices broadly, suggesting a need to continue broad training while expanding formal educational policies to include the full spectrum of ambulatory surgery.
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Affiliation(s)
| | - Jason Tong
- University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania
| | | | - Ezra S Brooks
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jon B Morris
- University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania
| | - Cary B Aarons
- University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania
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Callebaut I, Jorissen S, Pelckmans C, Berends N, Droogmans M, van Rossum M, Nulens M, Stessel B. Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery. Anesth Pain Med 2020; 10:e101669. [PMID: 32944560 PMCID: PMC7472168 DOI: 10.5812/aapm.101669] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background Nowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting. Objectives The current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery. Methods The current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4. Results Median average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent. Conclusions Each type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up.
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Affiliation(s)
- Ina Callebaut
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
| | - Steffe Jorissen
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
| | | | - Noor Berends
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
| | | | - Maxime van Rossum
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
| | - Marijke Nulens
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
| | - Bjorn Stessel
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
- Corresponding Author: Department of Anesthesiology and Pain, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
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Serra M, Vives R, Cañellas M, Planell J, Oliva JC, Colilles C, Pontes C. Outpatient multimodal intravenous analgesia in patients undergoing day-case surgery: description of a three year experience. BMC Anesthesiol 2016; 16:78. [PMID: 27619387 PMCID: PMC5020512 DOI: 10.1186/s12871-016-0246-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/21/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022] Open
Abstract
Background The use of elastomeric devices for ambulatory intravenous pain treatment in Major Ambulatory Surgery (MAS) has been described to improve postoperative pain management. The objective of the study was to describe the first 3 years experience of the use of elastomeric devices for ambulatory intravenous pain treatment in MAS implemented at our site since 2010. Methods Data were retrieved from the medical records for all patients who, between January 2010 and March 2014, underwent surgical procedures at the ambulatory surgical centre at our hospital and were prescribed a home-based continuous intravenous analgesia. Results Data were retrieved from the medical records of 1128 patients. The most frequent surgical interventions included orthopedic and proctology surgeries. 80 % of patients were discharged home without pain; during the first 48 h after discharge roughly 40 % of subjects were completely free of pain, 50 % reported mild pain (VAS 1 to 3) and 9 % reported higher pain scores (4 and above). Peripheral nerve block was associated to better pain control in the immediate postoperative period. Vomiting in the first 24 h was 4.6 % before introducing haloperidol into the drug schemes, and 2.6 % thereafter. Complications related with the intravenous route required treatment withdrawal in 1.1 % cases. Only 3.5 % of patients returned to the hospital in the first 72 h, mainly for non-pain related reasons. Overall, 99.5 % of patients were satisfied with the treatment received at home. Conclusion Our initial experience suggest that outpatient multimodal intravenous analgesia in patients undergoing day-case surgery is a feasible alternative in our setting, that allows an effective management of postoperative pain with a small rate of adverse events and complications requiring readmission.
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Affiliation(s)
- Magdalena Serra
- Anesthesiology Department, Hospital de Sabadell, Institut Universitari Parc Taulí - Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Roser Vives
- Clinical Pharmacology Unit, Hospital de Sabadell, Institut Universitari Parc Taulí - Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain.,Departamento de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Edifici Taulí planta -1 Hospital de Sabadell C/ Parc taulí n° 1, Sabadell, Barcelona, 08208, Spain
| | - Montserrat Cañellas
- Anesthesiology Department, Hospital de Sabadell, Institut Universitari Parc Taulí - Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Josep Planell
- Anesthesiology Department, Hospital de Sabadell, Institut Universitari Parc Taulí - Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Joan Carles Oliva
- Statistics Unit, Institut d'Investigació e Innovació Parc Taulí, Sabadell, Barcelona, Spain
| | - Carmen Colilles
- Anesthesiology Department, Hospital de Sabadell, Institut Universitari Parc Taulí - Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Caridad Pontes
- Clinical Pharmacology Unit, Hospital de Sabadell, Institut Universitari Parc Taulí - Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain. .,Departamento de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Edifici Taulí planta -1 Hospital de Sabadell C/ Parc taulí n° 1, Sabadell, Barcelona, 08208, Spain.
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Naumann DN, Zaman S, Daskalakis M, Nijjar R, Richardson M, Super P, Singhal R. Day surgery for achalasia cardia: Time for consensus? Ann R Coll Surg Engl 2016; 98:150-4. [PMID: 26829668 PMCID: PMC5210494 DOI: 10.1308/rcsann.2016.0063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Laparoscopic Heller's myotomy (LHM) is the most effective therapy for achalasia of the oesophagus. Most case series of LHM report a length of hospital stay (LOS) >1 day. We present 14 years of experience of LHM to examine the safety and feasibility of LHM as a day case procedure. METHODS We retrospectively examined patients undergoing elective LHM for achalasia at our institution between 2000 and 2014. Demographics, episode statistics, prior investigations and interventions were collated. Outcomes, including LOS, complications and re-interventions, were compared for the periods before and after a consensus decision at our institution in 2008 to perform LHM as a day case procedure. RESULTS Sixty patients with a mean age of 41 ± 13 years were included, of whom 58% were male. The median LOS for all patients was 1 day (interquartile range [IQR] 0-2.25). Overall, LHM was performed as a day case in 27 (45%) cases, at 2/26 (7.7%) in the first period versus 25/34 (73.5%) in the second (p<0.01). There were no significant differences in age, gender or previous interventions between day surgery and non-day surgery groups. One patient required subsequent unplanned surgery, while six (10%) needed endoscopic treatment of recurrent symptoms within 12 months. CONCLUSIONS LHM can be performed safely as a day case procedure. Complication rates are low, with only a small proportion of patients requiring endoscopic treatment for symptom recurrence within 1 year.
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Affiliation(s)
- D N Naumann
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - S Zaman
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - M Daskalakis
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - R Nijjar
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - M Richardson
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - P Super
- Heart of England NHS Foundation Trust , Birmingham , UK
| | - R Singhal
- Heart of England NHS Foundation Trust , Birmingham , UK
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Ahmad J, Ho OA, Carman WW, Thoma A, Lalonde DH, Lista F. Assessing patient safety in Canadian ambulatory surgery facilities: A national survey. Plast Surg (Oakv) 2014; 22:34-38. [PMID: 25152645 PMCID: PMC4128431] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND There has been increased interest regarding patient safety and standards of care in Canadian ambulatory surgery facilities where surgical procedures are performed. The Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF) is a national organization formed to establish and maintain standards to ensure that surgical procedures conducted outside of public hospitals are performed safely. OBJECTIVE To determine how many procedures are performed annually at CAAASF member sites, and to examine complication rates and several key patient safety practices. METHODS All 69 facilities accredited by the CAAASF were surveyed. The survey focused on procedural data, complication rates and patient safety interventions. RESULTS In 2010, 40,240 estimated procedures were performed. A total of 263 (0.007%) complications were reported. Sixteen (0.0004%) patients required reoperations in hospital and 19 (0.0004%) patients required transfer to hospital on the day of surgery. There were only two mortalities within 30 days of surgery reported in the past five years. With regard to patient safety practices, 93% used antimicrobial prophylaxis, 100% used strategies to maintain normothermia and 82% used measures for venous thromboembolism prevention. CONCLUSION The present study is the first to report on the Canadian experience in ambulatory surgery facilities and provides insight into current practices at these facilities. Appropriate accreditation of ambulatory surgery facilities, well-established patient safety-related standards of care, careful patient selection and procedures performed by qualified health care professionals with appropriate certification practicing within the scope of their practice form the basis for safe and effective ambulatory surgery.
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Affiliation(s)
| | - Olivia A Ho
- Division of Plastic and Reconstructive Surgery, University of Toronto
| | | | - Achilles Thoma
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario
| | - Donald H Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, St John, New Brunswick
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