Skin graft for the ambulatory patient

I have described a method of applying skin grafts in cases of varicose ulcer of the leg which has the following advantages: (1) it does not require hospitalization of the patient after grafting; (2) the time required for the healing of the ulcer is shortened, and it is economical for the patient.     

Major ambulatory surgery of the pediatric patient

Ambulatory surgery is an important part of the surgical care of children. Experience with 6972 pediatric surgical procedures performed in the Surgicenter is reviewed. Surgical techniques for the most common procedures--inguinal herniorrhaphy, orchiopexy, and umbilical herniorrhaphy--are described.     

Major ambulatory surgery of the otolaryngologic patient

Many otolaryngologic procedures can be performed safely on an ambulatory basis. Complications can be minimized by careful patient and procedure selection. This article describes common procedures adaptable to outpatient surgery and addresses the surgeon's added responsibility in this setting.     

Major ambulatory surgery of the ophthalmic patient

Ophthalmology, by means of its increased technologic abilities, has been a driving force in the movement toward ambulatory surgery over the past decade. In appropriate situations, nearly any ophthalmic procedure can be done in an outpatient setting. However, even though ophthalmic advances have helped the push toward ambulatory procedures, the future cohesiveness, as well as the superb patient care of ophthalmology, may be threatened in the pressure for cost reductions and efficiency.     

Major ambulatory surgery of the orthopedic patient

Orthopedic procedures that have been performed satisfactorily in an ambulatory setting are described. Ambulatory orthopedic surgery involves the same principles as inpatient orthopedic surgery. Explicit postoperative instructions to the patient and family member and the postoperative dressing are two factors of great importance in the ambulatory unit.     

Major ambulatory surgery of the plastic surgical patient

In the final analysis, a patient who does not require any more in the way of postoperative nursing care than bed rest and administration of food, water, and pain medication should be able to have surgery in an outpatient facility as safely and successfully as in an inpatient facility. A large general plastic surgery practice in an ambulatory surgical center creates unique problems, but most of these problems are solvable and have not prevented most plastic surgeons from conducting an ever increasing volume of their work in the ambulatory setting.     

Major ambulatory surgery of the gynecologic and obstetric patient

Many gynecologic and obstetric procedures can be done on an ambulatory basis. There is little difference in care between ambulatory and inpatient surgery during the preoperative and intraoperative periods. Thus, the primary deciding factor as to the appropriateness of ambulatory care rather than hospitalization lies in the postoperative requirements. These include the type and amount of analgesia that will be required, the intensiveness of nursing care needed, the need for unusual postoperative monitoring, the potential for complications, and the necessity for frequent postoperative evaluation by the surgeons.     

Monitoring of upper urinary tract pressures in the ambulatory patient

A new method to measure simultaneous intrarenal, intravesical and rectal pressures has been evaluated in 6 ambulatory patients with equivocal upper tract obstruction on radiological, renographic and standard Whitaker investigations.     

Factors influencing patient disposition after ambulatory herniorrhaphy

Purpose:

To determine factors associated with patient disposition status other than discharge to their customary residence (DCR) after elective, ambulatory inguinal hernia repair (IHR).

Materials and methods:

N = 7953 patients who underwent IHR were identified in the National Survey of Ambulatory Surgery (NSAS). Disposition status was examined by age, sex, race, type of anesthetic, anesthesia provider, expected source of payment, laterality of the procedure, facility type and US region. Logistic regression was used to examine independent risk factors for such disposition status.

Results:

Independent risk factors for disposition status other than DCR included anesthesia type, anesthesia provider, increasing age of the patient, and bi- versus unilaterality of the procedure. Differences in disposition status were also found by facility type and US region in which the procedure was performed.

Discussion:

The increased cost associated with a disposition status other than DCR requires identification of factors that independently contribute to such an outcome. In this study a number of anesthesia related and unrelated factors were identified that may impact on the disposition of patients undergoing ambulatory inguinal hernia repair. In light of limitations inherent to analysis of large databases our results should be interpreted with caution and prospective trials are needed for validation of our findings. The value of our results may lie particularly in the hypothesis generation for such trials.     

Inguinal herniorrhaphy in the continuous ambulatory peritoneal dialysis patient.

Inguinal hernia repair in the patient on continuous ambulatory peritoneal dialysis (CAPD) is complicated in theory by an increased potential for recurrence. In addition to the constant increased intraabdominal pressure, chronic renal failure has been shown to impair tissue healing. Controversy exists regarding the waiting period before resuming CAPD postoperatively. A retrospective review of all CAPD patients undergoing inguinal herniorrhaphy was performed. The patient's age, type of repair, duration of renal failure preoperatively, length of time on CAPD postoperatively, and date of resumption of CAPD were recorded. An inpatient and outpatient chart review was performed on all patients. Telephone follow-up was performed on surviving patients. From April 1981 to June 1989, 30 patients underwent 36 inguinal herniorrhaphies while on CAPD. One immediate postoperative death occurred due to underlying cardiac disease. The mean follow-up for surviving patients was 34 months (range, 16 to 91) and for those deceased was 25 months (range, 1 to 60). No recurrent hernias were identified either by extensive inpatient and outpatient chart review, or by direct patient telephone contact in all surviving patients. We conclude that inguinal herniorrhaphy can be safely performed in CAPD patients. Peritoneal dialysis can be initiated immediately after repair in this high-risk group of patients. There is a low risk of recurrence; however, long-term patient survival is not expected due to concurrent underlying medical problems.