Strope Seth A, Wolf J Stuart, Faerber Gary J, Roberts William W, Hollenbeck Brent K
Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA.
J Urol. 2009 Sep;182(3):1005-11. doi: 10.1016/j.juro.2009.05.012. Epub 2009 Jul 18.
Complex surgical procedures are migrating out of hospitals and into ambulatory surgery centers. We evaluated the extent to which surgery for urolithiasis could be a candidate for such migration.
Patients undergoing stone surgery in Florida (107,417) between 1998 and 2004 were included in the study. Poisson models were fit to assess temporal changes in the setting (inpatient, outpatient and ambulatory surgery center) and type (open, percutaneous, extracorporeal, ureteroscopy and stenting) of stone surgery. For inpatient procedures secular trends in comorbidity burden (0 or 1 diagnoses vs 2 or more) and procedure acuity (elective vs emergency) were also assessed. Admission requirements and mortality rates were measured according to the surgery setting.
Of the 107,417 discharges from 1998 to 2004 surgery rates per 100,000 increased from 35.5 to 38.2 for inpatients (p <0.05), 84.2 to 104.7 for hospital outpatients (p <0.01) and 9.4 to 26.9 for ambulatory surgery centers (p <0.01). For hospitalized patients routine admissions decreased (41.8% to 29.5%, p <0.01) and procedure acuity increased (16.8% to 28.2%, p <0.01). No deaths occurred at ambulatory surgery centers and the rate of admission to acute care hospitals was 2.5/100,000 cases.
Despite the safety and efficiency of ambulatory surgery centers hospital outpatient departments remain the preferred setting for urinary stone surgery. For patients requiring surgical intervention for urinary stone disease ambulatory surgery centers could be an underused resource.
复杂外科手术正从医院转移至门诊手术中心。我们评估了尿路结石手术在多大程度上适合这种转移。
纳入1998年至2004年在佛罗里达州接受结石手术的患者（107,417例）。采用泊松模型评估结石手术的手术地点（住院、门诊和门诊手术中心）和类型（开放手术、经皮手术、体外冲击波碎石术、输尿管镜检查和支架置入术）的时间变化。对于住院手术，还评估了合并症负担（0或1项诊断与2项或更多项诊断）和手术急症程度（择期与急诊）的长期趋势。根据手术地点测量入院要求和死亡率。
1998年至2004年的107,417例出院病例中，每10万人的住院手术率从35.5升至38.2（p<0.05），医院门诊手术率从84.2升至104.7（p<0.01），门诊手术中心手术率从9.4升至26.9（p<0.01）。对于住院患者，常规入院率下降（从41.8%降至29.5%，p<0.01），手术急症程度增加（从16.8%升至28.2%，p<0.01）。门诊手术中心无死亡病例，急性 care 医院的入院率为2.5/10万例。
尽管门诊手术中心具有安全性和效率，但医院门诊部仍是尿路结石手术的首选地点。对于需要手术干预治疗尿路结石疾病的患者，门诊手术中心可能是未得到充分利用的资源。
