Williams B A, DeRiso B M, Figallo C M, Anders J W, Engel L B, Sproul K A, Ilkin H, Harner C D, Fu F H, Nagarajan N J, Evans J H, Watkins W D
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh Medical Center, Montefiore University Hospital, PA 15213-2582, USA.
J Clin Anesth. 1998 Nov;10(7):570-8. doi: 10.1016/s0952-8180(98)00083-x.
(1) To incorporate regional anesthesia options for common outpatient orthopedic surgery into clinical pathways; (2) to use the clinical pathway format and the Procedural Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as management tools to measure postoperative same-day surgery processes and discharge outcomes; and (3) to determine the effects of general, regional, and combined general-regional anesthesia on these processes and outcomes.
Hospital database and patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995-1996 and 1996-1997. Patient data from AY 1995-1996, during which no intraoperative anesthesia clinical pathway existed, served as historical controls. Data from AY 1996-1997, during which intraoperative anesthesia clinical pathways were used, served as the treatment group.
Ambulatory surgery center in a teaching hospital.
The records of 503 ASA physical status I and II patients were reviewed. 1996-1997 patients selected general anesthesia (+/- femoral nerve block) or epidural anesthesia, after which the remainder of the perioperative anesthesia process was standardized with respect to the drugs and equipment used. 1995-1996 patients did not necessarily have a choice in anesthesia technique and did not have a standardized perioperative anesthetic course with respect to specific drugs and supplies. Intervals described in the AACD Procedural Times Glossary, anesthesia drug and supply costs, and patient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by anesthesia technique used, were measured. Combined general-regional anesthesia care for ACLR in 1996-1997, when compared with general anesthesia alone, led to increased pharmacy and materials costs and increased turnover time. However, patients with the combined technique showed improved recovery profiles and lower unexpected admission rates, and they required fewer nursing interventions for common postoperative symptoms. Patients receiving epidural anesthesia showed discharge outcomes similar to those patients receiving general anesthesia with femoral nerve block. Postanesthesia care unit bypass (fast-tracking) was more likely in clinical pathway regional anesthesia patients, when compared with the clinical pathway general anesthesia used.
Clinical pathway regional anesthesia care for outpatient orthopedics may have a significant role in simultaneously containing costs and improving both process efficiency and patient outcomes.
（1）将常见门诊骨科手术的区域麻醉选择纳入临床路径；（2）使用麻醉临床主任协会（AACD）发布的临床路径格式和手术时间术语表作为管理工具，以衡量术后当日手术流程和出院结果；（3）确定全身麻醉、区域麻醉以及全身 - 区域联合麻醉对这些流程和结果的影响。
对1995 - 1996学年和1996 - 1997学年连续接受前交叉韧带重建（ACLR）的患者进行医院数据库和病历审查。1995 - 1996学年的患者数据作为历史对照，该学年不存在术中麻醉临床路径。1996 - 1997学年的数据作为治疗组，该学年使用了术中麻醉临床路径。
一家教学医院的门诊手术中心。
回顾了503例ASA身体状况为I级和II级患者的记录。1996 - 1997学年的患者选择全身麻醉（±股神经阻滞）或硬膜外麻醉，此后围手术期麻醉过程的其余部分在所用药物和设备方面进行了标准化。1995 - 1996学年的患者在麻醉技术上不一定有选择，并且在特定药物和用品方面没有标准化的围手术期麻醉过程。测量了AACD手术时间术语表中描述的时间间隔、麻醉药物和用品成本以及受所用麻醉技术影响的患者结局变量（术后所需护理干预和意外入院情况）。与单纯全身麻醉相比，1996 - 1997学年ACLR的全身 - 区域联合麻醉护理导致药房和材料成本增加以及周转时间延长。然而，采用联合技术的患者恢复情况更好，意外入院率更低，并且他们因常见术后症状所需的护理干预更少。与使用临床路径全身麻醉的患者相比，临床路径区域麻醉患者更有可能绕过麻醉后护理单元（快速通道）。
门诊骨科的临床路径区域麻醉护理可能在同时控制成本以及提高流程效率和患者结局方面发挥重要作用。
