Aslam Muhammad I, Martin-Ucar Antonio E, Nakas Apostolos, Waller David A
Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK.
Interact Cardiovasc Thorac Surg. 2011 Nov;13(5):494-8. doi: 10.1510/icvts.2011.277707. Epub 2011 Aug 26.
A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.
自发性气胸急诊手术的术前延迟与术后不良预后及住院时间延长相关。为减少术前延迟,所有从地区综合医院转诊至我院胸外科的患者均通过“临床决策单元”(CDU)进行处理。在CDU设立之前,这些患者被列入手术床位等候名单。本研究回顾了这一入院政策变化对非选择性自发性气胸治疗效率的影响。对以下参数进行了组间比较(CDU前组与CDU后组):转诊至转运时间、转运至手术时间以及在转诊医院和三级医院的住院时间。在性别、诊断、转诊医院的治疗、术后临床结局或手术指征及类型方面无显著差异。CDU后组在转诊医院和三级医院的总住院时间显著缩短(12天对15天;P<0.001),这归因于患者更早被转运(18小时对78小时;P<0.001)。因此,允许手术进入传统内科住院单元具有成本效益,并显著提高了非选择性气胸手术的效率。