Segerdahl M, Warrén-Stomberg M, Rawal N, Brattwall M, Jakobsson J
Department of Clinical Science, Intervention and Technology, Unit for Anesthesia, Karolinska Institute, Stockholm, Sweden.
Acta Anaesthesiol Scand. 2008 Jan;52(1):117-24. doi: 10.1111/j.1399-6576.2007.01472.x. Epub 2007 Nov 8.
Day surgery has expanded considerably during the last decades. Routines and standards have developed but differ between and within countries.
We studied the practice of day surgery in Sweden by an extensive questionnaire survey sent to all 92 hospitals.
The proportion of day surgery vs. in-hospital procedures was overall 43%, with 43% in adults and 46% in children. Orthopaedic (33%), general (29%) and gynaecological (17%) surgery were the most common ambulatory procedures. Most patients (>90%) underwent pre-operative assessment by an anaesthesiologist. Patient self-assessment questionnaires were common (86%). Risk stratification for post-operative nausea and vomiting was used by 70% of the departments. Anxiolytic pre-medication was uncommon. Most anaesthesiologists (95%) used pre-operative oral analgesics to initiate post-operative analgesia, the most common being paracetamol (95%), NSAIDs (73%) and coxibs (15%). A balanced general anaesthesia technique was preferred. Post-operatively, 93% of the units routinely assessed patients' pain. Analgesic combinations of paracetamol, NSAIDs and weak opioids were used by 94% of the units. Most hospitals (80%) had standardised discharge criteria based on clinical assessment, and many required a patient escort at home for 24 h post-operatively. Assessments of unplanned admission, re-admission and post-operative complications were not performed routinely. Follow-up telephone calls within 1-2 days were performed regularly in about 40% of the units, or in selected patients only (37%). Pain was the most frequent complaint on follow-up.
In Sweden, a high degree of standardised regime for day surgical practice was found. Post-operative pain is the most common complaint after discharge.
日间手术在过去几十年中得到了显著发展。相关流程和标准已经形成，但各国之间以及国内各地区之间存在差异。
我们通过向瑞典所有92家医院发送广泛的问卷调查，研究了瑞典的日间手术实践情况。
日间手术与住院手术的比例总体为43%，其中成人患者为43%，儿童患者为46%。骨科手术（33%）、普通外科手术（29%）和妇科手术（17%）是最常见的门诊手术。大多数患者（>90%）接受了麻醉医生的术前评估。患者自我评估问卷很常见（86%）。70%的科室采用了术后恶心呕吐的风险分层。术前使用抗焦虑药物并不常见。大多数麻醉医生（95%）使用术前口服镇痛药来启动术后镇痛，最常用的是对乙酰氨基酚（95%）、非甾体抗炎药（73%）和环氧化酶-2抑制剂（15%）。首选平衡全身麻醉技术。术后，93%的科室常规评估患者疼痛。94%的科室使用对乙酰氨基酚、非甾体抗炎药和弱阿片类药物的镇痛组合。大多数医院（80%）根据临床评估制定了标准化的出院标准，许多医院要求患者术后在家有24小时的陪护。未对计划外入院、再次入院和术后并发症进行常规评估。约40%的科室或仅对部分选定患者（37%）在术后1 - 2天进行定期随访电话。随访中最常见的抱怨是疼痛。
在瑞典，日间手术实践存在高度标准化的模式。术后疼痛是出院后最常见的抱怨。
