Khan Azhar, Abrams Paul
Bristol Urological Institute, Southmead Hospital, Bristol, UK.
BJU Int. 2009 Mar;103(5):640-4. doi: 10.1111/j.1464-410X.2008.08125.x. Epub 2008 Oct 24.
To explore, by an audit, the regional practice of inserting a suprapubic catheter (SPC), and to prospectively determine the proportion of patients that can be successfully managed on an outpatient basis in one department.
Both local and regional practice were determined by a retrospective analysis of the hospital database for all cases of SPC insertion between April 2005 and March 2006. In addition, a questionnaire was e-mailed to each of 11 urology departments. Locally, from August 2006 onwards, all patients scheduled for SPC insertion were referred to a new clinic, where the SPC was inserted using a new SPC kit and the Seldinger technique.
Locally, 66 patients (mean age 70 years, range 26-93) had a SPC inserted between April 2005 and March 2006; 49 had an elective procedure while 17 were emergency admissions. The median (range) hospital stay was 3.5 (1-85) days. Within the region, 480 SPCs were inserted in theatre during the same period, of which 52% (249) were inserted as elective inpatients, 11% (52) were inserted as a day case, and 37% (179) had SPCs as emergency admissions. A nurse-led outpatient service was available in two hospitals, where 89% of patients seen in the clinic had successful insertion under local anaesthesia, and only 11% were referred for insertion under general anasthesia. Between August 2006 and July 2007, 50 of 54 patients had a SPC inserted successfully in the new SPC clinic. There were no major complications. The cost benefits of adopting an outpatient management strategy were significant, at approximately GB 100,000 pounds/year in our hospital, 790,000 pounds/year in the region and 9,500,000 pounds/year for the UK.
An outpatient procedure for a SPC is safe and feasible in most patients, and its widespread use would produce considerable cost savings.
通过一项审计来探究耻骨上膀胱造瘘管（SPC）插入术的区域实践情况，并前瞻性地确定在一个科室中能够成功进行门诊治疗的患者比例。
通过回顾性分析2005年4月至2006年3月期间所有SPC插入术病例的医院数据库来确定当地和区域的实践情况。此外，还向11个泌尿外科科室分别发送了一份调查问卷。在当地，从2006年8月起，所有计划进行SPC插入术的患者都被转至一个新诊所，在那里使用新的SPC套件和Seldinger技术插入SPC。
在当地，2005年4月至2006年3月期间有66例患者（平均年龄70岁，范围26 - 93岁）接受了SPC插入术；49例为择期手术，17例为急诊入院。中位（范围）住院时间为3.5（1 - 85）天。在该区域内，同期有480例SPC在手术室插入，其中52%（249例）作为择期住院患者插入，11%（52例）作为日间手术插入，37%（179例）为急诊入院患者插入SPC。两家医院提供由护士主导的门诊服务，在诊所就诊的患者中89%在局部麻醉下成功插入，仅11%被转诊接受全身麻醉下插入。2006年8月至2007年7月期间，54例患者中有50例在新的SPC诊所成功插入SPC。无重大并发症。采用门诊管理策略的成本效益显著，在我们医院约为每年100,000英镑，在该区域为每年790,000英镑，在英国为每年9,500,000英镑。
SPC门诊手术对大多数患者来说是安全可行的，其广泛应用将节省大量成本。
