Department of Anesthesiology, Perioperative and Pain Medicine.
Center for Perioperative Research, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Curr Opin Anaesthesiol. 2019 Dec;32(6):756-761. doi: 10.1097/ACO.0000000000000789.
Although both cost and patient preference tend to favor the office-based setting, one must consider the hidden costs in managing complications and readmissions. The purpose of this review is to provide an update on safety outcomes of office-based procedures, as well as to identify common patient-specific factors that influence the decision for office-based surgery or impact patient outcomes.
Office-based anesthesia (OBA) success rates from the latest publications of orthopedic, plastic, endovascular, and otolaryngologic continue to improve. A common thread among these studies is the ability to predict which patients will benefit from going home the same day, as well as identifying comorbid factors that would lead to failure to discharge or readmission after surgery. Specifically, patients with active infection, cardiovascular disease, coagulopathy, insulin-dependent diabetes, obesity, obstructive sleep apnea, poorly controlled hypertension, and thromboembolic disease are presumed to be poor candidates for outpatient office procedures.
Overall, anesthesia and surgery in the office is becoming increasingly safe. Recent data suggest that the improved safety in the office-based setting is attributable to proper patient selection. Anesthesiologists play a critical role in prescreening eligible patients to ensure a safe and productive process. Patients treated in the office seem to be selected based on their low risk for complications, and our review reflects this position.
目的综述：尽管成本和患者偏好都倾向于选择在门诊进行治疗，但我们必须考虑到管理并发症和再入院所带来的隐性成本。本篇综述旨在提供最新的门诊手术安全性结果，并确定影响门诊手术决策或影响患者预后的常见患者特定因素。
最新发现：骨科、整形、血管内和耳鼻喉科领域最新出版物中，门诊麻醉（OBA）的成功率持续提高。这些研究的一个共同点是，能够预测哪些患者将从当天回家中受益，并确定导致术后无法出院或再入院的合并症因素。具体而言，患有活动性感染、心血管疾病、凝血障碍、胰岛素依赖型糖尿病、肥胖症、阻塞性睡眠呼吸暂停、未控制的高血压和血栓栓塞性疾病的患者，被认为是门诊手术的不合适人选。
总结：总体而言，在门诊进行麻醉和手术变得越来越安全。最近的数据表明，门诊环境安全性的提高归因于患者的适当选择。麻醉师在筛选合格患者方面发挥着关键作用，以确保安全有效的治疗过程。在门诊接受治疗的患者似乎是基于其低并发症风险进行选择的，我们的综述反映了这一立场。
