Pavlin D J, Rapp S E, Polissar N L, Malmgren J A, Koerschgen M, Keyes H
Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195, USA.
Anesth Analg. 1998 Oct;87(4):816-26. doi: 10.1097/00000539-199810000-00014.
Discharge time (total recovery time) is one determinant of the overall cost of outpatient surgery. We performed this study to determine what factors affect discharge time. Details regarding patients, anesthesia, surgery, and recovery were recorded prospectively for 1088 adult patients undergoing ambulatory surgery over an 8-mo period. The contribution of factors to variability in the discharge time was assessed by using multivariate linear regression analysis. In the last 4 mo of the study, nurses indicated the causes of discharge delays > or =50 min in Phase 1 or > or =70 min in Phase 2 recovery. When all anesthetic techniques were included, anesthetic technique was the most important determinant of discharge time (R2 = 0.10-0.15; P = 0.001), followed by the Phase 2 nurse. After general anesthesia, the Phase 2 nurse was the most important factor (R2 = 0.13; P = 0.01-0.001). In women, the choice of general anesthetic drugs was significant (R2 = 0.04; P = 0.002). The three most common medical causes of delay were pain, drowsiness, and nausea/vomiting. System factors were the foremost cause of Phase 2 delays (41%), with lack of immediate availability of an escort accounting for 53% of system-related delays. We conclude that efforts to shorten discharge time would best be directed at improving nursing efficiency; ensuring availability of an escort for the patient; and preventing postoperative pain, drowsiness, and emetic symptoms. The selection of anesthetic technique and anesthetic drug seems to be of selective importance in determining discharge time depending on patient gender and type of surgery.
The relative importance of anesthetic and nonanesthetic factors were evaluated as determinants of discharge time after ambulatory surgery. Postoperative nursing care was the single most important factor after general anesthesia; anesthetic drugs, anesthetic technique, and prevention of pain and emetic symptoms were of selective importance depending on patient gender and type of surgery.
出院时间（总恢复时间）是门诊手术总成本的一个决定因素。我们开展这项研究以确定哪些因素会影响出院时间。前瞻性记录了8个月期间1088例接受门诊手术的成年患者的患者、麻醉、手术及恢复的详细情况。通过多元线性回归分析评估各因素对出院时间变异性的影响。在研究的最后4个月，护士指出了在第1阶段延迟出院≥50分钟或在第2阶段恢复延迟出院≥70分钟的原因。当纳入所有麻醉技术时，麻醉技术是出院时间的最重要决定因素（R2 = 0.10 - 0.15；P = 0.001），其次是第2阶段的护士。全身麻醉后，第2阶段的护士是最重要的因素（R2 = 0.13；P = 0.01 - 0.001）。在女性患者中，全身麻醉药物的选择具有显著影响（R2 = 0.04；P = 0.002）。导致延迟的三个最常见医学原因是疼痛、嗜睡和恶心/呕吐。系统因素是第2阶段延迟的首要原因（41%），其中缺乏护送人员即时可用占系统相关延迟的53%。我们得出结论，缩短出院时间最好的努力方向是提高护理效率；确保为患者提供护送人员；以及预防术后疼痛、嗜睡和呕吐症状。麻醉技术和麻醉药物的选择在根据患者性别和手术类型确定出院时间方面似乎具有选择性重要性。
评估了麻醉和非麻醉因素作为门诊手术后出院时间决定因素的相对重要性。全身麻醉后，术后护理是唯一最重要的因素；麻醉药物、麻醉技术以及预防疼痛和呕吐症状根据患者性别和手术类型具有选择性重要性。
