Yasuhara Takao, Hishikawa Tomohito, Agari Takashi, Kurozumi Kazuhiko, Ichikawa Tomotsugu, Kameda Masahiro, Shinko Aiko, Ishida Joji, Hiramatsu Masafumi, Kobayashi Motomu, Matsuoka Yoshikazu, Sasaki Toshihiro, Soga Yoshihiko, Yamanaka Reiko, Ashiwa Takako, Arioka Akemi, Hashimoto Yasuko, Misaki Ayasa, Ishihara Yuriko, Sato Machiko, Morimatsu Hiroshi, Date Isao
Department of Neurological Surgery, Okayama University Graduate School of Medicine.
Neurol Med Chir (Tokyo). 2016 Sep 15;56(9):574-9. doi: 10.2176/nmc.oa.2016-0085. Epub 2016 Jul 11.
Perioperative management is critical for positive neurosurgical outcomes. In order to maintain safe and authentic perioperative management, a perioperative management center (PERIO) was introduced to patients of our Neurosurgery Department beginning in June 2014. PERIO involves a multidisciplinary team consisting of anesthesiologists, dentists/dental hygienists/technicians, nurses, physical therapists, pharmacists, and nutritionists. After neurosurgeons decide on the course of surgery, a preoperative evaluation consisting of blood sampling, electrocardiogram, chest X-ray, and lung function test was performed. The patients then visited the PERIO clinic 7-14 days before surgery. One or two days before surgery, the patients without particular issues enter the hospital and receive a mouth cleaning one day before surgery. After surgery, postoperative support involving eating/swallowing evaluation, rehabilitation, and pain control is provided. The differences in duration from admission to surgery, cancellation of surgery, and postoperative complications between PERIO and non-PERIO groups were examined. Eighty-five patients were enrolled in the PERIO group and 131 patients in the non-PERIO group. The duration from admission to surgery was significantly decreased in the PERIO group (3.6 ± 0.3 days), compared to that in the non-PERIO group (4.7 ± 0.2 days). There was one cancelled surgery in the PERIO group and six in the non-PERIO group. Postoperative complications and the overall hospital stay did not differ between the two groups. The PERIO system decreased the duration from admission to surgery, and it is useful in providing high-quality medical service, although the system should be improved so as not to increase the burden on medical staff.
围手术期管理对于神经外科手术取得良好预后至关重要。为了维持安全且可靠的围手术期管理，自2014年6月起，我们神经外科向患者引入了围手术期管理中心（PERIO）。PERIO由一个多学科团队组成，成员包括麻醉师、牙医/口腔保健员/技师、护士、物理治疗师、药剂师和营养师。神经外科医生确定手术方案后，会进行包括采血、心电图、胸部X光和肺功能测试在内的术前评估。然后患者在手术前7 - 14天前往PERIO诊所。手术前一或两天，没有特殊问题的患者入院，并在手术前一天接受口腔清洁。术后，提供包括进食/吞咽评估、康复和疼痛控制在内的术后支持。研究了PERIO组和非PERIO组在入院至手术的时长、手术取消情况以及术后并发症方面的差异。PERIO组纳入了85名患者，非PERIO组纳入了131名患者。与非PERIO组（4.7±0.2天）相比，PERIO组入院至手术的时长显著缩短（3.6±0.3天）。PERIO组有1例手术取消，非PERIO组有6例。两组术后并发症和总体住院时间没有差异。PERIO系统缩短了入院至手术的时长，有助于提供高质量医疗服务，不过该系统应加以改进，以免增加医务人员的负担。
