Parent satisfaction with paediatric day-surgery: a questionnaire-based study

Potential advantages of paediatric day-surgery are cost saving, improved utilization of staff and hospital facilities, and reduction of stress for the paediatric patient and their family. A successful programme requires careful case selection, full operating and anaesthetic facilities and good follow-up. Current practice is reviewed with regard to initial assessment, preparation for surgery and overall management during the day admission. To provide information on how patients and their parents experience essential aspects of daycare paediatric surgery, a questionnaire-based study on parental satisfaction of paediatric day-surgery was performed. Most children were back to normal, within a few days. Recovery from paediatric day-surgery was rapid and the overall level of parent satisfaction was high.     

一日腹腔镜胆囊切除术26例分析

目的:探讨一日腹腔镜胆囊切除术的可行性。方法:将同一位医师进行的腹腔镜胆囊切除术患者经选择连续纳入研究范围。常规腹腔镜组30例,一日腹腔镜组26例。患者出院后通过电话问卷调查其满意度,并对其临床资料进行统计、对比分析,统计整夜留院率、再次住院率、并发症率和满意度。结果:患者都认同腹腔镜胆囊切除术。一日腹腔镜组4例需整夜留院(15.4%),1例需再次住院(3.8%),24例(92.3%)对一日腹腔镜胆囊切除术满意或非常满意,无并发症发生。结论:一日腹腔镜胆囊切除术和常规腹腔镜胆囊切除术一样安全可行,并具有较低的整夜留院率、再次住院率和很高的满意度。     

A fatal case of post-operative pulmonary thromboembolism with cosmetic liposuction

Pulmonary thromboembolism (PTE) has been regarded as rare in Japan. However, PTE has been increasingly recognised because either of increased incidence, diagnostic progress, or social recognition. Recently, 10 Japanese Medical Associations have submitted preventive guidelines for PTE in post-operative patients and the government decided to fund this, as results of the increase in cases and concern regarding medical negligence. A fatal case of PTE after liposuction is reported. A female patient was in the home toilet after two days of immobilization following day-surgery liposuction. Clinicians must be aware of appropriate methods for the prevention of post operative PTE with cosmetic surgery.     

日间经皮肾镜碎石取石术患者延迟出院的危险因素分析和列线图构建

目的探讨日间经皮肾镜碎石取石术（PCNL）患者延迟出院的危险因素,并构建风险预测列线图。 方法回顾性审查370例日间PCNL患者的电子病历,根据患者是否在24 h内出入院,将其分为延迟出院组（61例）和正常出院组（309例）。采用单因素分析比较两组的一般资料、术后1 h生命体征和血液学指标。通过Logistic回归分析确定延迟出院的危险因素,绘制列线图以预测延迟出院的风险,应用校准曲线评估列线图的内部校准性能。 结果370例患者中有61例（16.5%）出现延迟出院,18例（4.9%）住院时间超过48 h。Logistic回归分析显示年龄>65岁（OR：3.992,95%CI：1.792~8.892,P=0.001）、通道数量（OR：3.139,95%CI：1.548~6.367,P=0.002）、术中严重出血（OR：12.207,95%CI：2.761~53.973,P=0.001）、术后1 h体温>38℃（OR：4.623,95%CI：1.445~14.789,P=0.010）、中性粒细胞比率>75%（OR：1.951,95%CI：1.008~3.777,P=0.047）和钾<3.5 mmol/L（OR：5.469,95%CI：1.641~18.226,P=0.006）是日间PCNL患者延迟出院的独立危险因素。延迟出院预测模型的ROC曲线下面积为0.784,通过危险因素构建的列线图具有良好的区分度和准确性。 结论基于年龄、通道数量、术中严重出血、术后感染和低钾血症构建的延迟出院风险预测列线图预测性能良好,可帮助医护人员快速识别术后延迟出院高风险患者,以便尽早实施医疗干预。     

Safety of middle-ear day-surgery in children: A STROBE observational study

ObjectiveThe main objective of this pediatric study of otologic surgery was to analyze factors for success of outpatient management. The secondary objective was to study unscheduled postoperative consultations and readmissions.Materials and methodsThis retrospective observational study analyzed clinical characteristics and procedures in consecutive children undergoing major ear surgery over a 3-year period in a teaching hospital. The study followed STROBE recommendations.ResultsWe included 214 day-cases from a total population of 271 children. Median age was 109 ± 44 months (9 years) [range: 8–196 months (16 years)]. In 57% of cases, the procedure was performed without mastoidectomy: 84 myringoplasties and 37 tympanoplasties. In 43% of cases, mastoidectomy was associated: 47 cochlear implants and 46 closed tympanoplasties for cholesteatoma. Ninety-five percent of day-surgeries were successful; in 5%, there was crossover to pediatric ENT department admission, for the following symptoms: postoperative nausea and vomiting in 3 cases, pain in 3, and late awakening in 5. Univariate analysis showed a relationship between failure and age under 36 months (P = 0.002). There were no readmissions. There were unscheduled consultations in 3% of cases: for minor otorrhagia in 5 cases and uncomplicated otorrhea in 2.ConclusionMajor otologic surgery in children is compatible with day-surgery. Younger patients, usually candidates for cochlear implantation, had greater risk of crossover to conventional admission. In this age group, scheduling should be earlier in the morning, with rigorous postoperative nausea and vomiting prophylaxis.     

日间手术临时取消原因分析及对策

目的分析日间手术病房手术临时取消原因,并提出相应对策,以利于提高日间手术病房工作效率及医疗质量。方法对2012年10月-2013年10月985例次日间手术临时取消患者进行回顾性研究及相关原因分析。结果日间手术临时取消的主要原因有疾病因素、患者及家属临时拒绝手术、术前准备不足、意外等。结论医务人员必须加强责任心,各部门协调配合,做好慢性疾病的术前治疗,做好患者术前健康教育及心理疏导,降低日间手术临时取消率。