*Department of Anesthesia †Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
J Neurosurg Anesthesiol. 2014 Jan;26(1):60-4. doi: 10.1097/ANA.0b013e3182991d8b.
Ambulatory day surgery is an evolving specialty in line with demands of modern medicine, health care services, and economics, but its role in neurovascular surgery remains controversial. The purpose of this study was to describe our experience of patients undergoing elective clipping of intact cerebral aneurysms as day surgery.
This retrospective and prospective observational study was carried out as a cohort review of patients who underwent outpatient clipping of an intact intracranial aneurysm at the Toronto Western Hospital, University Health Network, between May 2009 and November 2012. Patients were categorized as success (discharged on the same day) or failure (requiring unplanned postoperative hospital admission) of day surgery. Data included the preoperative assessment of the patient, anesthetic management, postoperative care, and the incidence of perioperative complications. Outcomes were duration of hospital stay, and any problems preventing same-day discharge.
During the study period 25 patients aged 54±9 years underwent outpatient aneurysm repair. Seventeen patients (68%) successfully completed day surgery, and 8 patients (32%) were admitted to the hospital after surgery due to perioperative complications. Duration of hospital stay in the failure group ranged from 2 to 18 days.
Our data demonstrates that surgical clipping of unruptured cerebral aneurysms may be performed in an outpatient setting. Careful selection of day surgery candidates and postoperative assessment for complications is needed. Further research is needed to identify potential risk factors and to target patient subgroups for successful ambulatory surgery.
随着现代医学、医疗保健服务和经济学的需求，门诊日间手术是一个不断发展的专业领域，但它在神经血管外科中的作用仍存在争议。本研究的目的是描述我们对择期夹闭未破裂脑动脉瘤的患者进行日间手术的经验。
这是一项回顾性和前瞻性观察性研究，对 2009 年 5 月至 2012 年 11 月期间在多伦多西部医院、大学健康网络进行门诊夹闭颅内未破裂动脉瘤的患者进行了队列回顾。患者分为日间手术成功（当天出院）或失败（需要计划外术后住院）。数据包括患者术前评估、麻醉管理、术后护理以及围手术期并发症的发生率。结果包括住院时间和任何阻止当天出院的问题。
在研究期间，25 名 54±9 岁的患者接受了门诊动脉瘤修复。17 名患者（68%）成功完成了日间手术，8 名患者（32%）因围手术期并发症而在手术后住院。失败组的住院时间从 2 天到 18 天不等。
我们的数据表明，未破裂脑动脉瘤的外科夹闭可以在门诊环境下进行。需要仔细选择日间手术候选者，并对并发症进行术后评估。需要进一步研究以确定潜在的危险因素，并针对成功的日间手术患者亚组进行靶向治疗。
