Pei Sophia, Olteanu Daniel, Manzar Daud, Thomas Rhea, Huq Nasimul
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Surgery, McMaster University, Hamilton, ON, Canada.
Plast Surg (Oakv). 2025 Apr 30:22925503251334392. doi: 10.1177/22925503251334392.
This study compares complication rates for minor reconstructive procedures done under local anesthesia in a hospital setting versus out-of-hospital premises (OHP) setting during the COVID-19 pandemic. If it could be shown that minor plastic surgeries have similar, if not reduced, complication types and frequencies, this would provide a strong rationale for more procedures to be delegated to non-hospital office settings. Not only would complication rates be lower for patients, resulting in improved quality of life and health outcomes, but there would be increased efficiency for minor plastic surgery procedures, improved patient wait times, and reduced burden on hospital resources to allow for accommodation of more complex and major procedures that cannot be performed elsewhere. This is a retrospective medical record review of patients who underwent minor plastic surgery procedures at a community hospital and OHP settings. All procedures were performed by the same plastic surgeon. Minor plastic procedures were defined as day procedures performed with only local anesthesia. Procedures were completed with field sterility (eg, use of drapes and sterile gloves) but not room sterility. A total of 2739 charts (537 hospital charts and 2202 clinic charts) from January 2022 to December 2022, were reviewed with annotation of patient demographics, procedure type, procedure site, follow-up dates, complications, and complication type, if any. Statistical analysis involving chi-squared tests was performed on anonymized data to primarily compare complication rates between the hospital and the outpatient clinic setting, as well as secondary comparisons of subgroups such as patients with diabetes and patients using blood thinners. There was a 3.5% complication rate for the minor procedures in the hospital compared to 1.2% in OHP setting which was a statistically significant finding. There were fewer complications for patients undergoing minor reconstructive procedures in an outpatient clinic setting versus in-hospital, indicating the potential for delegation of minor surgeries to OHP clinics and ambulatory surgery centers.
本研究比较了在新冠疫情期间，在医院环境与院外场所（OHP）进行局部麻醉下的小型重建手术的并发症发生率。如果能够证明小型整形手术的并发症类型和发生率相似甚至更低，这将为将更多手术委托给非医院办公场所提供有力的理由。这不仅会降低患者的并发症发生率，从而改善生活质量和健康结果，还会提高小型整形手术的效率，缩短患者等待时间，并减轻医院资源负担，以便能够接纳更多无法在其他地方进行的复杂和大型手术。这是一项对在社区医院和OHP场所接受小型整形手术的患者的回顾性病历审查。所有手术均由同一位整形外科医生进行。小型整形手术被定义为仅在局部麻醉下进行的日间手术。手术在术野无菌（例如使用手术巾和无菌手套）的情况下完成，但不是在手术室无菌环境下进行。对2022年1月至2022年12月期间的总共2739份病历（537份医院病历和2202份诊所病历）进行了审查，记录了患者的人口统计学信息、手术类型、手术部位、随访日期、并发症以及并发症类型（如有）。对匿名数据进行了涉及卡方检验的统计分析，主要比较医院和门诊诊所环境之间的并发症发生率，以及对糖尿病患者和使用血液稀释剂患者等亚组进行二次比较。医院小型手术的并发症发生率为3.5%，而OHP场所为1.2%，这是一个具有统计学意义的发现。与住院患者相比，门诊诊所环境下接受小型重建手术的患者并发症更少，这表明将小型手术委托给OHP诊所和门诊手术中心具有潜力。
