Johnson C D, Jarrett P E
Kingston Hospital, Surrey.
Ann R Coll Surg Engl. 1990 Jul;72(4):225-8.
This paper reports a 5-year experience of a surgical day case unit. Over 10,000 patients were treated in the three specialties of gynaecology, orthopaedics and general surgery. Seventy patients (0.7%) were admitted to the inpatient beds of the hospital directly from the day case unit. These patients were reviewed to determine if any avoidable factors had played a part. Two-fifths of the admissions after suction termination of pregnancy were of patients of more than 12 weeks' gestation. Admission was necessary on 10 occasions after orthopaedic and general surgical operations when the procedure was too extensive or too painful to allow the patient to be discharged home. Complications of anaesthesia, either local (n = 5) or general (n = 15), constituted the largest cause for admission. Postoperative nausea, vomiting and drowsiness became less frequent after a change in technique to the use of a short-acting anaesthetic agent (12 in the 3 years before; two in the 2 years after). Day case surgery is safe and should rarely be followed by the need for hospital admission. Based on our experience, we recommend the use of short-acting agents for general anaesthesia, and we advise against day case surgery in patients who require a general anaesthetic for longer than 60 min, or who need extensive surgery.
本文报告了一个外科日间手术单元的5年经验。超过10000名患者在妇科、骨科和普通外科这三个专科接受了治疗。70名患者（0.7%）从日间手术单元直接被收治到医院的住院病床。对这些患者进行了评估，以确定是否有任何可避免的因素起了作用。在人工流产术后被收治的患者中，五分之二的患者妊娠超过12周。在骨科和普通外科手术后，有10次因手术范围过大或疼痛过于剧烈而无法让患者出院回家，因此有必要收治住院。麻醉并发症，无论是局部麻醉（n = 5）还是全身麻醉（n = 15），都是收治住院的最大原因。在改用短效麻醉剂后，术后恶心、呕吐和嗜睡的情况变得不那么频繁了（之前3年有12例；之后2年有2例）。日间手术是安全的，很少需要随后住院治疗。根据我们的经验，我们建议使用短效麻醉剂进行全身麻醉，并且我们不建议对需要全身麻醉超过60分钟或需要进行大型手术的患者进行日间手术。
