Lechot A, De Gabory L
Rev Laryngol Otol Rhinol (Bord). 2013;134(4-5):191-7.
Feasibility assessment of septoplasty and septorhinoplasty as ambulatory procedures, from analysis of the activity of a university ENT department.
This is a retrospective analysis over 2 years. The demographic data, the distance between the patient's home and the ENT department, the cause of the septal deviation, the exact kind of surgery, the time of the beginning of the anaesthesia, the duration of the surgery, the postoperative data, the complications and the duration of hospitalization were collected. The operating durations were compared according to the sex, to the cause of the septal deviation, to previous surgery or not and to the kind of surgery performed, using Mann-Whitney's test. The correlations between the age, the operating duration and the time of the beginning of the anaesthesia were estimated using Spearman's test. Then, all the criteria of eligibility for an ambulatory surgical procedure were applied to this population, taking into account or not the distance between the patient's home and the ENT department. A financial analysis was realized on the eligible population, comparing the earnings for a traditional hospitalization with an ambulatory one.
424 patients were included, with an average age of 38 years old. 47 patients had an anaesthetic contraindication for the ambulatory surgery. 226 nasoseptal deviations were congenital (53.3%) and 198 post-traumatic (46.7%). 353 patients had never had a nasoseptal surgery (83.25%). The average time of the beginning of the anaesthesia was 10:55 am. The average durations were 75.8 +/- 32 min for septoplasty versus 127.5 +/- 44 min for the other acts (p < 10-5). There was a strong statistical difference of operating durations between a first surgery and a secondary surgical revision; as well as between a congenital cause and post-traumatic one (p < 10-5). There was an inverse correlation between the age and the operating duration (p < 10-4) and a correlation between the age and the time of the beginning of the anaesthesia (p < 10-5). 23 patients (5.42%) suffered from pains, nausea/vomitings and epistaxis within the 6 postoperative hours, that would have prevented them from going back home. 23 patients (5.42%) presented hematoma, infections, scar disunity, pains and faintness between day 4 and day 8 after surgery. In all, considering a distance shorter then an 1 hour drive from the ENT department, 69 patients (16.3%) were eligible retrospectively for an ambulatory surgery; they would have been 154 (40.8%) in the absence of this criteria. The medico-economic earnings would have been about 39,900 euros for 69 patients, for 2 years.
17 to 40% of the patients were potentially eligible for an ambulatory procedure, without endangering them.
通过分析某大学耳鼻喉科的活动情况，对鼻中隔成形术和鼻整形术作为门诊手术的可行性进行评估。
这是一项为期2年的回顾性分析。收集了患者的人口统计学数据、患者家与耳鼻喉科之间的距离、鼻中隔偏曲的原因、确切的手术类型、麻醉开始时间、手术时长、术后数据、并发症及住院时长。使用曼-惠特尼检验，根据性别、鼻中隔偏曲的原因、是否曾接受过手术以及所实施的手术类型对手术时长进行比较。使用斯皮尔曼检验估计年龄、手术时长与麻醉开始时间之间的相关性。然后，将门诊手术的所有合格标准应用于该人群，同时考虑或不考虑患者家与耳鼻喉科之间的距离。对符合条件的人群进行了财务分析，比较了传统住院治疗与门诊治疗的收益情况。
共纳入424例患者，平均年龄38岁。47例患者存在门诊手术的麻醉禁忌证。226例鼻中隔偏曲为先天性（53.3%），198例为创伤后（46.7%）。353例患者从未接受过鼻中隔手术（83.25%）。麻醉开始的平均时间为上午10:55。鼻中隔成形术的平均时长为75.8±32分钟，其他手术的平均时长为127.5±44分钟（p<10⁻⁵）。初次手术与二次手术翻修之间以及先天性病因与创伤后病因之间的手术时长存在显著统计学差异（p<10⁻⁵）。年龄与手术时长之间存在负相关（p<10⁻⁴），年龄与麻醉开始时间之间存在相关性（p<10⁻⁵）。23例患者（5.42%）在术后6小时内出现疼痛、恶心/呕吐和鼻出血，这会妨碍他们回家。23例患者（5.42%）在术后第4天至第8天出现血肿、感染、瘢痕裂开、疼痛和头晕。总体而言，考虑到距离耳鼻喉科车程短于1小时，69例患者（16.3%）回顾性符合门诊手术条件；若不考虑该标准，符合条件的患者将有154例（40.8%）。两年内，69例患者的医疗经济效益约为39,900欧元。
17%至40%的患者可能适合门诊手术，且不会对他们造成危害。
