Menezes Ana Sousa, Guimarães Joana R, Breda Miguel, Vieira Vicente, Dias Luís
Department of Otolaryngology-Head and Neck Surgery, Hospital De Braga, Braga, Portugal.
Department of Anesthesiology of Hospital De Braga, Braga, Portugal.
Eur Arch Otorhinolaryngol. 2018 Jan;275(1):131-138. doi: 10.1007/s00405-017-4813-3. Epub 2017 Nov 20.
The performance of septoplasty and turbinate surgery in an outpatient basis is an increasingly established practice, although is still a controversial topic.
Retrospective analysis of 227 patients who underwent septoplasty ± inferior and/or middle turbinoplasty. Demographic, clinical, surgical, and anesthetic data were collected. Our primary outcomes were rates of perioperative complications, prolongation of hospital stay (PHS), unexpected hospital revisits (UHR), or readmissions within 30 days of surgery.
The UHR rate was 4.8 and 6.6% in the first 48 h and 30 postoperative days, respectively. The main reasons were nasal obstruction, self-limited epistaxis, and gastrointestinal intolerance to the prescribed antibiotic. Four patients required PHS due to nausea or vomiting and asthenia. There were no intraoperative complications, readmissions to the operative room, or hospital readmissions after discharge. The addiction of turbinate procedures was not associated with higher risk of complications. Patients with PHS were younger than those discharged as scheduled. There was no association between complications and comorbidities, gender, ASA classification, revision surgery, surgeon's grading, technique of inferior turbinoplasty, type of nasal packing, duration of anesthesia, and operative time.
The UHR rate of septoplasty performed at our unit is above that recommended for ambulatory procedures, but is within the range previously published and no major complications were seen. Septoplasty and turbinate surgery, including middle turbinate surgery, have a great potential to be undertaken as a day-case procedure, being patient selection the cornerstone of safe and efficient perioperative care.
鼻中隔成形术和鼻甲手术在门诊进行的做法越来越普遍，尽管这仍是一个有争议的话题。
对227例行鼻中隔成形术±下鼻甲和/或中鼻甲成形术的患者进行回顾性分析。收集人口统计学、临床、手术和麻醉数据。我们的主要结局指标是围手术期并发症发生率、住院时间延长（PHS）、意外再次入院（UHR）或术后30天内再次入院情况。
术后48小时内和术后30天的UHR发生率分别为4.8%和6.6%。主要原因是鼻塞、自限性鼻出血以及对处方抗生素的胃肠道不耐受。4例患者因恶心、呕吐和乏力需要延长住院时间。术中无并发症发生，未再次进入手术室，出院后也未再次入院。鼻甲手术的附加操作与更高的并发症风险无关。延长住院时间的患者比按计划出院的患者年轻。并发症与合并症、性别、美国麻醉医师协会（ASA）分级、翻修手术、外科医生分级、下鼻甲成形术技术、鼻腔填塞类型、麻醉持续时间和手术时间之间均无关联。
我们科室进行的鼻中隔成形术的UHR发生率高于门诊手术推荐的发生率，但在先前公布的范围内，且未观察到重大并发症。鼻中隔成形术和鼻甲手术，包括中鼻甲手术，作为日间手术有很大潜力，患者选择是安全、高效围手术期护理的基石。
