Carlsen A W
Ugeskr Laeger. 1989 May 8;151(19):1179-81.
Two hundred and thirty, 142 men and 88 women with an average age of 34 years were admitted as single-day patients for knee joint arthroscopy or arthroscopic knee surgery, after assessment as outpatients. Arthroscopy under local anaesthesia was undertaken in 112 patients prior to admission while 118 patients were admitted solely on the basis of clinical examination. Arthroscopic operations were carried out in 155 patients while diagnostic examinations only were carried out in 75 patients. The frequency of the patients in whom therapeutic intervention was undertaken was significantly higher when the admission had been preceded by outpatient diagnostic arthroscopy (p less than 0.001). In 21 cases (9%) admission to a regular department proved necessary in four patients on account of the knee and in 17 patients on account of sequelae of the anaesthesia. It was of no significance for the number of patients requiring more prolonged hospitalization whether arthroscopic operation or solely diagnostic intervention had been undertaken and, similarly the significance of a blood-free operating field was of no significance in this respect. The duration of the operation had no influence upon the discharge either. General anaesthesia resulted in more cases of prolonged hospitalisation than epidural or spinal analgesia. No surgical complications occurred. The only complication of significance occurred after epidural analgesia with a symptom-producing dural lesion. It is concluded that single-day admissions are very feasible in patients who have been assessed as outpatients in view of the anaesthetic risk and who have been meticulously informed about the course of hospitalization.
230名患者(142名男性和88名女性,平均年龄34岁)在门诊评估后作为日间患者接受膝关节镜检查或关节镜膝关节手术。112名患者在入院前接受了局部麻醉下的关节镜检查,而118名患者仅根据临床检查入院。155名患者进行了关节镜手术,75名患者仅进行了诊断检查。在门诊诊断性关节镜检查后入院的患者中,进行治疗干预的频率显著更高(p<0.001)。21例(9%)患者因膝关节问题4例、麻醉后遗症17例而需要转入常规科室。进行关节镜手术还是仅进行诊断性干预,对于需要更长时间住院的患者数量没有影响,同样,无血手术视野在这方面也没有意义。手术时间对出院也没有影响。全身麻醉导致延长住院时间的病例比硬膜外或脊髓镇痛更多。未发生手术并发症。唯一有意义的并发症发生在硬膜外镇痛后,出现了有症状的硬脊膜病变。结论是,鉴于麻醉风险且已向患者详细告知住院过程,对于已在门诊评估的患者,日间入院是非常可行的。