Menguy R, Roth R M
Services de Chirurgie, Ecole de Médecine, l'université de Rochester, Le Genesee Hospital, New York 14607.
Chirurgie. 1990;116(8-9):579-84; discussion 585.
Ambulatory surgery has been gaining momentum in the United States over the past decade. This does not result from an initiative taken by the medical profession, but from a government plan aimed at checking the soaring costs of medical care. Since this rise was chiefly caused by hospital costs, the attempted savings have primarily affected our privilege of admitting the patients to hospital as we wanted. It has become impossible to admit a patient to hospital for diagnostic testing. Even for major surgery (such as resection of the esophagus, duodenopancreatotomy, etc.), the patient comes to hospital on the very morning of the operation. In addition, the medical mutual benefit insurance companies, in particular, the HMOs, have decided that some operations must be performed without any stay in hospital. This has resulted in the creation of ambulatory surgery units, which were either integrated in hospital surgery departments, or independent, and of which we discuss the pros and cons. In addition, an infrastructure aimed at facilitating postoperative care at home or in smaller private units has been set up. Laparoscopic surgery has further increased the percentage of ambulatory operations. There certainly will be no retreat now.
在过去十年里，门诊手术在美国越来越流行。这并非源于医疗行业的主动行为，而是源于一项旨在控制医疗费用飙升的政府计划。由于费用上涨主要是由医院成本导致的，所以节省开支的举措主要影响了我们按照自己意愿收治病人入院的特权。现在已经不可能为了诊断性检查而收治病人入院了。即使是大型手术（如食管切除术、十二指肠胰腺切开术等），病人也是在手术当天上午才来医院。此外，医疗互助保险公司，特别是健康维护组织（HMO），已经决定某些手术必须在不住院的情况下进行。这导致了门诊手术单元的设立，这些单元要么整合在医院外科部门，要么独立存在，我们将讨论其优缺点。此外，还建立了一个旨在方便病人在家中或小型私人机构接受术后护理的基础设施。腹腔镜手术进一步提高了门诊手术的比例。现在肯定不会退缩了。
