Carty N J, Curtis N J, Ranaboldo C J
Department of Surgery, Salisbury District Hospital, Odstock Road, Salisbury, SP2 8BJ, UK.
Surg Endosc. 2016 Dec;30(12):5565-5571. doi: 10.1007/s00464-016-4929-3. Epub 2016 Apr 29.
For some common conditions, pre-operative clinic visits are often of little value to the patient or surgeon with transfer to the waiting list being predictable. In response to local patient feedback, we introduced a single hospital visit laparoscopic hernia surgery pathway with focus on informed consent, patient-reported outcomes and post-operative interaction with primary care services.
A single hospital visit service for elective hernia repairs was created. Patients were not excluded on age, BMI or co-morbidity. Following referral, patients were telephoned by a surgeon. If considered appropriate, a symptom assessment tool, procedure information and consent form were sent. All patients were operated without attending clinic or pre-operative assessment. Surgeon-led telephone follow-up was made at either 2 or 7 days post-operatively and patient satisfaction assessed at 3 months.
A total of 517 patients were referred for single-stop surgery between 2012 and 2015. Median age was 58 (range 20-92), 91 % were male, and mean BMI was 25.6 (17.4-52.0). No patient refused the single-visit pathway. Single-stop patients had higher knowledge questionnaire scores (mean 16 vs. 10, p = 0.01) than patients who had attended clinic. Nine (1.7 %) were requested to attend clinic to confirm diagnosis, and three (0.8 %) were cancelled by their surgeon on the operative day. A total of 393 hernia repairs (331 TEP, 63 open) were performed under general anaesthetic. 92 % were discharged on day zero. Telephone follow-up day two rather than seven decreased attendance to primary care services (25 % vs. 57 %, p = 0.001). At 3 months, 95 % were satisfied and symptom scores were reduced (median 5-0, p < 0.0001).
Single-visit surgery appears to extend the patient benefits of laparoscopy by reducing hospital visits without compromising safety. Single hospital visit hernia surgery for unselected primary care referrals is possible and acceptable to patients.
对于一些常见病症，术前门诊就诊对患者或外科医生往往价值不大，因为转入等候名单是可预测的。为回应当地患者的反馈，我们引入了一种单次医院就诊的腹腔镜疝修补手术路径，重点关注知情同意、患者报告的结果以及术后与基层医疗服务的互动。
创建了一种针对择期疝修补的单次医院就诊服务。患者不因年龄、体重指数或合并症而被排除。转诊后，外科医生会给患者打电话。如果认为合适，会发送症状评估工具、手术信息和同意书。所有患者均未参加门诊或术前评估即接受手术。术后第2天或第7天由外科医生进行电话随访，并在3个月时评估患者满意度。
2012年至2015年期间，共有517例患者被转诊进行一站式手术。中位年龄为58岁（范围20 - 92岁），91%为男性，平均体重指数为25.6（17.4 - 52.0）。没有患者拒绝单次就诊路径。一站式手术患者的知识问卷得分（平均16分对10分，p = 0.01）高于参加门诊的患者。9例（1.7%）被要求到门诊确认诊断，3例（0.8%）在手术当天被外科医生取消手术。共在全身麻醉下进行了393例疝修补手术（331例TEP，63例开放手术）。92%的患者在术后第0天出院。术后第2天而非第7天进行电话随访可减少患者到基层医疗服务机构就诊的次数（25%对57%，p = 0.001）。在3个月时，95%的患者表示满意，症状评分降低（中位值从5降至0，p < 0.0001）。
单次就诊手术似乎通过减少医院就诊次数而不影响安全性，扩大了腹腔镜手术对患者的益处。对于未经筛选的基层医疗转诊患者，单次医院就诊疝修补手术是可行的且患者可接受。
