Department of Orthopaedic Surgery, Division of Hand and Upper Extremity, The Ohio State University Wexner Medical Center, Columbus, Ohio
Hand & UpperEx Center, Wexford, Pennsylvania.
J Bone Joint Surg Am. 2016 Apr 20;98(8):700-4. doi: 10.2106/JBJS.15.00239.
More procedures are being completed on an outpatient basis at freestanding ambulatory surgery centers. The purpose of our study was to determine the safety and rate of adverse events in outpatient hand and upper-extremity surgical procedures.
A retrospective review of cases at a single, freestanding ambulatory surgery center over an eleven-year period was performed. In our analysis, 28,737 cases were performed and were included. Adverse events were defined as serious complications causing harm to a patient or leading to additional treatment. Using state-reportable adverse events criteria as a guideline, we divided the adverse events into seven categories: infection requiring intravenous antibiotics or return to the operating room, postoperative transfer to a hospital, wrong-site surgical procedure, retention of a foreign object, postoperative symptomatic thromboembolism, medication error, and bleeding complications. These adverse events were then analyzed to determine if they led to additional laboratory testing, hospital admission, return to the operating room, emergency department visits, or physical or mental permanent disability.
There were fifty-eight reported adverse events, for an overall rate of 0.20%. There were no deaths. There were fourteen infections, eighteen postoperative transfers to a hospital, twenty-one hospital admissions after discharge, one medication error, and four postoperative hematomas. There were no cases of wrong-site surgical procedures or retained foreign bodies.
Our study shows that, with a selected patient population, a very low adverse event rate (0.20%) can be achieved. Our review showing few adverse events, no deaths, and no wrong-site surgical procedures supports our view that hand and upper-extremity surgical procedures can be completed safely in the outpatient setting at a freestanding ambulatory surgery center.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
越来越多的门诊手术在独立的门诊手术中心进行。我们研究的目的是确定门诊手部和上肢手术的安全性和不良事件发生率。
对一家独立的门诊手术中心十一年间的病例进行回顾性分析。在我们的分析中，共进行了 28737 例手术，均包括在内。不良事件定义为对患者造成伤害或导致额外治疗的严重并发症。我们使用州报告的不良事件标准作为指导，将不良事件分为七类：需要静脉使用抗生素或返回手术室的感染、术后转院、手术部位错误、异物残留、术后症状性血栓栓塞、用药错误和出血并发症。然后分析这些不良事件，以确定它们是否导致额外的实验室检查、住院、返回手术室、急诊就诊或身体或精神永久性残疾。
报告了 58 例不良事件，总发生率为 0.20%。无死亡病例。有 14 例感染、18 例术后转院、21 例出院后住院、1 例用药错误和 4 例术后血肿。无手术部位错误或异物残留的病例。
我们的研究表明，对于选定的患者人群，可以达到非常低的不良事件发生率（0.20%）。我们的回顾显示不良事件少、无死亡、无手术部位错误，支持我们的观点，即手部和上肢手术可以在独立的门诊手术中心安全地在门诊进行。
治疗性 IV 级。请参阅作者说明，以获取完整的证据水平描述。
