Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, F-94276, Le Kremlin Bicetre, France; Inserm, Centre of research in Epidemiology and population health (CESP), U1018, F-94276, Villejuif, France; Faculty of medicine, Université Paris-Saclay, F-94276, Le Kremlin Bicetre, France.
Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, F-94276, Le Kremlin Bicetre, France.
J Gynecol Obstet Hum Reprod. 2022 Oct;51(8):102437. doi: 10.1016/j.jogoh.2022.102437. Epub 2022 Jul 2.
Hospital-day-care surgery is currently a priority for the healthcare system and is booming due to its' favorable financial impact. In gynecology, the management of surgical interventions for patients who've come to the Hospital Emergency Department, could in a number of cases, be delayed for a few h or several days. It would be it possible to organize a specific hospital day-care management program for the delayed surgeries. The aim of the study is to evaluate the feasibility of hospital day-care management of delayed gynecological emergencies.
This is a prospective, observational, unicentric study performed in the gynecological department of a teaching hospital from January 2016 through March 2017. Women having gynecological emergencies requiring surgical management were included in this study. The leading causes for surgical management and thus for inclusion in this study were nonviable pregnancies or retained products of conception, vulvar or breast abscesses, ectopic pregnancies and complications of ovarian cysts. For women with emergencies that could be delayed, surgery was scheduled between 12 h and 12 days after a woman's initial emergency examination at the hospital. Postoperative consultation was at the emergency department or completed by the referring physician. Re-hospitalization and re-intervention rates were collected 6 to 8 weeks after the initial emergency management.
Three hundred and forty-eight women requiring surgical management consulted for gynecological emergencies over the period of the study. One hundred and eighty-one (52%) were managed in delayed day-care. The rate of surgical emergency management between the initial emergency consultation and the delayed day-care surgery was 1.8%. The consultation rate of a return to the emergency department prior to the planned delayed day-care was 12.2% (21/171). The rate of unplanned re-admissions in the month following surgery was 1.8% (3/171). The overall Satisfaction rate was high (170/171 99.4%).
The delayed surgical management of gynecological emergencies thus seems feasible and beneficial for both women and the healthcare system. An economic evaluation could be performed to evaluate the lower costs/savings for delayed day-care management of gynecological emergencies.
日间手术目前是医疗体系的重点，由于其良好的财务影响而蓬勃发展。在妇科，对于已到急诊部的患者的手术干预的管理，在许多情况下，可能会延迟数小时或数天。对于延迟的手术，可以组织特定的日间手术管理方案。本研究的目的是评估延迟妇科急症的日间手术管理的可行性。
这是一项前瞻性、观察性、单中心研究，于 2016 年 1 月至 2017 年 3 月在一所教学医院的妇科进行。本研究纳入需要手术治疗的妇科急症患者。导致手术治疗从而纳入本研究的主要原因是非活产妊娠或妊娠组织残留、外阴或乳房脓肿、异位妊娠和卵巢囊肿并发症。对于可以延迟的急症患者，手术安排在女性在医院初次急诊检查后 12 小时至 12 天之间。术后咨询在急诊部进行或由转诊医生完成。在初次急症管理后 6 至 8 周收集再次住院和再次干预的发生率。
研究期间，有 348 名需要手术治疗的女性因妇科急症就诊。181 例（52%）在延迟日间护理中得到治疗。在初次急诊咨询和延迟日间护理手术之间进行手术急症管理的比例为 1.8%。在计划的延迟日间护理前返回急诊部的咨询率为 12.2%（21/171）。手术后一个月内计划外再次入院的比例为 1.8%（3/171）。总体满意度很高（170/171，99.4%）。
因此，妇科急症的延迟手术管理似乎是可行的，对女性和医疗体系都有益。可以进行经济评估，以评估妇科急症延迟日间护理管理的较低成本/节省。
