Fleisher L A, Yee K, Lillemoe K D, Talamini M A, Yeo C J, Heath R, Bass E, Snyder D S, Parker S D
Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Anesthesiology. 1999 Jun;90(6):1746-55. doi: 10.1097/00000542-199906000-00033.
There is increasing pressure to perform traditional inpatient surgical procedures in an outpatient setting. The aim of the current trial was to determine the safety and cost savings of performing laparoscopic cholecystectomy in an outpatient setting using a "mock" outpatient setting.
Patients who were scheduled for laparoscopic cholecystectomy by four attending surgeons and for whom operating time was available in the outpatient center were studied. All patients received a standardized anesthetic, including ondansetron, and were discharged from the outpatient postanesthesia care unit if appropriate. At discharge, all patients were admitted to a clinical research center where they were observed in a "mock home" setting and monitored for complications that would have necessitated readmission. A decision analysis was created assuming all patients underwent outpatient surgery with either direct admission or discharge to home and readmission if complications developed.
Of 99 patients who were enrolled in this study, 96 patients would have met the discharge criteria for home. No major complications were observed in these 96 patients. Eleven patients experienced postoperative nausea and vomiting, 3 of whom required an additional 24 h of hospital observation. In the decision model, the optimal strategy would be to perform the procedure on an outpatient basis and readmit patients only for complications, with an average baseline cost savings of $742/patient.
The results show that outpatient laparoscopic cholecystectomy is safe and cost-effective in selected patients, and that the mock home setting provides a means of studying the safety of transition of care.
在门诊环境中开展传统住院手术的压力日益增大。当前试验的目的是确定在模拟门诊环境中进行腹腔镜胆囊切除术的安全性和成本节约情况。
对由四位主治外科医生安排进行腹腔镜胆囊切除术且在门诊中心有可用手术时间的患者进行研究。所有患者均接受标准化麻醉，包括昂丹司琼，若情况合适则从门诊麻醉后护理单元出院。出院时，所有患者被收治到临床研究中心，在模拟家庭环境中接受观察，并监测可能需要再次入院的并发症。创建了一个决策分析模型，假设所有患者都接受门诊手术，要么直接入院，要么出院回家，若出现并发症则再次入院。
在纳入本研究的99例患者中，96例符合出院回家的标准。这96例患者未观察到重大并发症。11例患者出现术后恶心和呕吐，其中3例需要额外24小时的住院观察。在决策模型中，最佳策略是在门诊进行手术，仅因并发症再次收治患者，平均每位患者可节约基线成本742美元。
结果表明，门诊腹腔镜胆囊切除术在特定患者中是安全且具有成本效益的，模拟家庭环境为研究护理过渡的安全性提供了一种方法。
