Tolvi Morag, Tuominen-Salo Hanna, Paavola Mika, Mattila Kimmo, Aaltonen Leena-Maija, Lehtonen Lasse
Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland.
Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Patient Saf Surg. 2020 Jun 26;14:27. doi: 10.1186/s13037-020-00249-3. eCollection 2020.
While previous studies have evaluated the effect of some patient characteristics (e.g. gender, American Society of Anesthesiologists (ASA) class and comorbidity) on outcome in orthopedic and hand day surgery, more detailed information on anesthesia related factors has previously been lacking. Our goal was to investigate the perioperative factors that affect overstay, readmission and contact after day surgery in order to find certain patient profiles more prone to problemed outcomes after day surgery.
We examined orthopedic and hand day surgery at an orthopedic day surgery unit of Helsinki University Hospital. Patient data of all adult orthopedic and hand day surgery patients ( = 542) over a 3-month period (January 1 - March 31, 2015) operated on at the unit were collected retrospectively using the hospital's surgery database. These data comprised anesthesia and patient records with a follow-up period of 30 days post-operation. Patients under the age of 16 and patients not eligible for day surgery were excluded. Patient records were searched for an outcome of overstay, readmission or contact with the emergency room or policlinic. Pearson chi-square test, Fischer's exact test and multivariable logistic regression were used to analyze the effect of various perioperative factors on postoperative outcome.
Various patient and anesthesia related factors were examined for their significance in the outcomes of overstay, readmission or contact. Female gender ( = 0.043), total amount of fentanyl ( = 0.00), use of remifentanil ( = 0.036), other pain medication during procedure ( = 0.005) and administration of antiemetic medication ( = 0.048) emerged as statistically significant on outcome after day surgery.
Overstay and readmission in orthopedic and hand day surgery were clearly connected with female patients undergoing general anesthesia and needing larger amounts of intraoperative opioids. By favoring local and regional anesthesia, side effects of general anesthesia, as well as recovery time, will decrease.
虽然先前的研究评估了一些患者特征（如性别、美国麻醉医师协会（ASA）分级和合并症）对骨科和手部日间手术结局的影响，但此前缺乏关于麻醉相关因素的更详细信息。我们的目标是调查影响日间手术后延长住院时间、再次入院和联系情况的围手术期因素，以便找出某些在日间手术后更容易出现问题结局的患者特征。
我们在赫尔辛基大学医院的一个骨科日间手术单元对骨科和手部日间手术进行了检查。使用医院的手术数据库，回顾性收集了该单元在3个月期间（2015年1月1日至3月31日）接受手术的所有成年骨科和手部日间手术患者（n = 542）的患者数据。这些数据包括麻醉和患者记录，随访期为术后30天。排除16岁以下患者和不符合日间手术条件的患者。在患者记录中查找延长住院时间、再次入院或与急诊室或门诊联系的结局情况。使用Pearson卡方检验、Fisher精确检验和多变量逻辑回归分析各种围手术期因素对术后结局的影响。
检查了各种患者和麻醉相关因素在延长住院时间、再次入院或联系结局中的意义。女性性别（P = 0.043）、芬太尼总量（P = 0.00）、瑞芬太尼的使用（P = 0.036）、手术过程中使用其他止痛药物（P = 0.005）和使用止吐药物（P = 0.048）在日间手术后的结局中具有统计学意义。
骨科和手部日间手术中的延长住院时间和再次入院与接受全身麻醉且术中需要大量阿片类药物的女性患者明显相关。采用局部和区域麻醉，全身麻醉的副作用以及恢复时间将会减少。
