Faiz O D, Brown T J, Colucci G, Grover M, Clark S K
Department of Colorectal Surgery, St. Mark's Hospital, Harrow, Middlesex, UK.
Colorectal Dis. 2008 Nov;10(9):935-42. doi: 10.1111/j.1463-1318.2008.01481.x. Epub 2008 Feb 21.
Day case surgery is safe and offers potential benefits to both patients and healthcare providers. This study aimed to describe national changes in colorectal day case workload between 1998 and 2005.
Admission data relating to Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures (4th revision) (OPCS-4) coloproctology operation codes were analysed using the Hospital Episode Statistics (HES) database. Day case rates (DCRs) were calculated as the proportion of elective cases performed on an ambulatory basis.
In total, 3 119 058 colorectal admissions were recorded on the HES database between 1998 and 2005; 1 891 474 (61%) of these were for lower gastrointestinal endoscopies. Emergency cases accounted for 527 665 (17%), elective inpatient cases for 406 368 (13%) and elective day cases for 293 551 (9%) admissions. Throughout the study period the DCRs for five commonly performed elective colorectal procedures were: 0.70 for anal lesion excisions (OPCS-4 codes: H48.1, H48.2 and H48.3); 0.16 for haemorrhoidectomy (OPCS-4 code: H51.1); 0.63 for anal fissure procedures (OPCS-4 codes: H56.2 and H56.4); 0.39 for elective procedures for anal fistula (OPCS-4 codes: H55.1, H55.2, H55.3 and H55.4); 0.37 for elective pilonidal surgery (OPCS-4 codes: H59 and H60.2). Two emergency operations, drainage of perianal and pilonidal abscesses (OPCS-4 codes: H58.2 and H60.3 respectively), were identified as operations potentially amenable to day surgery. Over the seven study years, an annual average of 8559 (+/-SD 307) admissions were coded to drainage of a perianal abscess and 4676 (+/-SD 478) admissions to drainage of pilonidal abscess. The average annual bed usage associated with these procedures was 18 831 (+/-SD 718) and 7623 (+/-SD 436) bed days respectively.
Colorectal day case surgery is currently under-exploited in the NHS. By lifting some of the barriers to day case surgery significant resource savings may be possible.
日间手术是安全的，对患者和医疗服务提供者都有潜在益处。本研究旨在描述1998年至2005年间全国结直肠日间手术工作量的变化。
使用医院事件统计（HES）数据库分析与人口普查和调查局外科手术和操作分类（第4版）（OPCS - 4）结直肠外科手术编码相关的入院数据。日间手术率（DCR）计算为门诊进行的择期病例的比例。
1998年至2005年间，HES数据库共记录了3119058例结直肠入院病例；其中1891474例（61%）为下消化道内镜检查。急诊病例占527665例（17%），择期住院病例占406368例（13%），择期日间手术病例占293551例（9%）。在整个研究期间，五种常见的择期结直肠手术的日间手术率分别为：肛门病变切除术为0.70（OPCS - 4编码：H48.1、H48.2和H48.3）；痔切除术为0.16（OPCS - 4编码：H51.1）；肛裂手术为0.63（OPCS - 4编码：H56.2和H56.4）；肛瘘择期手术为0.39（OPCS - 4编码：H55.1、H55.2、H55.3和H55.4）；择期藏毛窦手术为0.37（OPCS - 4编码：H59和H60.2）。两项急诊手术，肛周和藏毛窦脓肿引流术（分别为OPCS - 4编码：H58.2和H60.3），被确定为可能适合日间手术的操作。在七年的研究期间，肛周脓肿引流术每年平均有8559例（±标准差307）入院病例被编码，藏毛窦脓肿引流术每年平均有4676例（±标准差478）入院病例。与这些手术相关的平均每年床位使用天数分别为18831天（±标准差718）和7623天（±标准差436）。
目前，国民保健服务体系（NHS）中结直肠日间手术的利用不足。通过消除一些日间手术的障碍，可能会节省大量资源。
