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Enhanced recovery after surgery protocols for outpatient operations in otolaryngology:Review of literature

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World Journal of Otorhinolaryngology-Head and Neck surgery 2022年第2期8卷 96-106页

作者： Kevin Chorath Sara Hobday Neeraj V.Suresh Beatrice Go Alvaro Moreira Karthik Rajasekaran Department of Otorhinolaryngology University of PennsylvaniaPhiladelphiaPennsylvaniaUSA Department of Pediatrics University of Texas Health-San AntonioSan AntonioTexasUSA Leonard Davis Institute of Health Economics University of PennsylvaniaPhiladelphiaPennsylvaniaUSA

Objective:Enhanced recovery after surgery(ERAS)protocols are patient-centered,evidence-based pathways designed to reduce complications,promote recovery,and improve outcomes following *** protocols have been successfully applied for the management of head and neck cancer,but relatively few studies have investigated the applicability of these pathways for other outpatient procedures in *** goal was to perform a systematic review of available evidence reporting the utility of ERAS protocols for the management of patients undergoing outpatient otolaryngology ***:A systematic literature review was conducted using MEDLINE,EMBASE,SCOPUS,and gray *** identified studies that evaluated ERAS protocols among patients undergoing otologic,laryngeal,nasal/sinus,pediatric,and general otolaryngology *** assessed the outcomes and ERAS components across protocols as well as the study design and ***:A total of eight studies fulfilled the inclusion criteria and were included in the *** of procedures evaluated with ERAS protocols included tonsillectomy and adenoidectomy,functional endoscopic sinus surgery,tympanoplasty and mastoidectomy,and septoplasty.A reduction in postoperative length of stay and hospital costs was reported in two and three studies,*** studies between ERAS and control groups showed persistent improvement in pre-and postoperative anxiety and pain levels,without an increase in postoperative complications and readmission ***:A limited number of studies discuss implementation of ERAS protocols for outpatient operations in *** clinical pathways appear promising for these procedures as they may reduce length of stay,decrease costs,and improve pain and anxiety postoperatively.

关键词： enhanced recovery after surgery otolaryngology outpatient surgery patient safety PSQI

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outpatient single-incision laparoscopic cholecystectomy in 22 patients with gallbladder disease

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Hepatobiliary & Pancreatic Diseases International 2010年第6期9卷 629-633页

作者： Wu Ji,Kai Ding,Rong Yang,Xing-Dong Liu,Ning Li and Jie-Shou Li Research Institute of General surgery,Jinling Hospital, Nanjing University School of Medicine,Nanjing 210002,China Research Institute of General surgery Jinling Hospital Nanjing University School of Medicine Nanjing 210002 China.

BACKGROUND:Transumbilical single-incision laparoscopic cholecystectomy(SILC)is a new *** has been described by some authors as scarless *** our knowledge,however, there has been no study on outpatient *** present study was designed to determine the safety,feasibility and benefits of transumbilical outpatient SILC. METHODS:Twenty-two patients underwent transumbilical outpatient SILC at our department from December 2008 to October *** all patients,the preoperative work-up and operation were completed in the outpatient *** perform the operation,a 2-to 2.5-cm semi-circular incision was made around the umbilicus and three 5-mm trocars were inserted separately by direct puncture.A 5-mm flexible laparoscope, an UltraCision harmonic scalpel and curved instruments were used to perform the laparoscopic cholecystectomy(LC) procedure. RESULTS:All patients except one were operated on successfully. The conversion rate to standard LC was 5%.In the 21 successfully completed patients,the median duration of operation was 56.5 minutes and estimated operative blood loss was 16.2 *** time to resume liquid food was 10.8 hours and semi-liquid food was 16.2 hours after the *** patients went home on the same day,and 12 on the second day after the *** mean postoperative hospital observation time was 18.5 *** retention was observed in 1 *** follow-up was conducted for all patients at 2 weeks after *** patients were satisfied with the good cosmetic effect of the *** total satisfaction rate was 95%.CONCLUSIONS:outpatient SILC is a safe and feasible technique for operating with fewer scars and reducing perioperative discomfort at the same time.A direct puncture method to insert trocars is technically *** a flexible laparoscope and curved instruments make the procedure easier and more time-saving.

关键词： single-incision surgery outpatient surgery laparoscopic cholecystectomy natural orifice transluminal endoscopic surgery

outpatient versus inpatient laparoscopic cholecystectomy:a single center clinical analysis

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Hepatobiliary & Pancreatic Diseases International 2010年第1期9卷 60-64页

作者： Ji, Wu Ding, Kai Li, Ling-Tang Wang, Dan Li, Ning Li, Jie-Shou Nanjing Univ Sch Med Jinling Hosp Res Inst Gen Surg Nanjing 210002 Peoples R China

BACKGROUND: outpatient laparoscopic cholecystectomy (OPLC) developed in the United States and other developed countries as one of the fast-track surgeries performed in ambulatory centers. However, this practice has not been installed as a routine practice in the major general hospitals and medical centers in China. We designed this case-control study to evaluate the feasibility, benefits, and safety of OPLC. METHODS: Two hundred patients who had received laparoscopic cholecystectomy for various benign gallbladder pathologies from April 2007 to December 2008 at Jinling Hospital of Nanjing University School of Medicine were classified into two groups: OPLC group (100 patients), and control group (100), who were designated for inpatient laparoscopic cholecystectomy (IPLC). Data were collected for age, gender, indications for surgery, American Society of Anesthesiology (ASA) class, operative time, blood loss during surgery, length of hospitalization, and intra- and post-operative complications. The expenses of surgery and in-hospital care were calculated and analyzed. The operative procedures and instrumentation were standardized for laparoscopic cholecystectomy, and the procedures were performed by two attending surgeons specialized in laparoscopic surgery. OPLC was selected according to the standard criteria developed by surgeons in our hospital after review. Reasons for conversion from laparoscopic to open cholecystectomy were recorded and documented. RESULTS: One hundred patients underwent IPLC following the selection criteria for the procedure, and 99% completed the procedure. The median operative time for IPLC was 24.0 minutes, blood loss was 16.2 ml, and the time for resuming liquid then soft diet was 10.7 hours and 22.0 hours, respectively. Only one patient had postoperative urinary infection. The mean hospital stay for IPLC was 58.2 hours, and the cost for surgery and hospitalization was 8770.5 RMB yuan on average. Followup showed that 90% of the patients were

关键词： laparoscopic cholecystectomy outpatient surgery fast-track surgery

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Comparing complications of outpatient management of slipped capital femoral epiphysis and Blount’s disease:A database study

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World Journal of Orthopedics 2022年第4期13卷 373-380页

作者： Achraf Jardaly Timothy W Torrez Gerald McGwin Shawn R Gilbert Department of Orthopaedics Hughston Foundation/Hughston ClinicColumbusGA 31909United States Department of Orthopedics University of AlabamaBirminghamAL 35205United States Department of Epidemiology Center of Clinical and Translational ScienceUniversity of Alabama at BirminghamBirminghamAL 35205United States Department of Pediatric Orthopaedics University of Alabama at BirminghamBirminghamAL 35233United States

BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient *** recent examples include slipped capital femoral epiphysis(SCFE)and Blount’s *** indications are well-studied for each pathology,but to our knowledge,there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either *** believed there would be no increase in adverse outcomes associated with outpatient treatment of either *** To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse *** The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics,rates of complications,and readmissions between outpatient and inpatient surgery for SCFE and Blount’s *** Total 1788 SCFE database entries were included,30%were performed in an outpatient *** situ pinning was used in 98.5%of outpatient surgeries and 87.8%of inpatient surgeries(Poutpatients 2.57%and 1.65%*** Blount’s disease,outpatient surgeries constituted 41.2%of the 189 procedures included in our *** majority of inpatients were treated with a tibial osteotomy,while the majority of outpatients had a physeal arrest(Poutpatient *** can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of compl

关键词： outpatient surgery Early discharge Slipped capital femoral epiphysis Blount’s disease

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腹腔镜胆囊切除术在门诊的应用与研究

腹腔镜胆囊切除术在门诊的应用与研究

作者：李建海浙江大学

学位级别：硕士

目的：门诊腹腔镜胆囊切除(outpatient laparoscopic cholecystectomy，OPLC)的可行性和可能性在国内还未广泛认同。此项连续前瞻性研究探讨门诊腹腔镜胆囊切除是否安全、经济而具可行性。方法：共有55位经选择患者加入此项研究。其中... 详细信息

目的：门诊腹腔镜胆囊切除(outpatient laparoscopic cholecystectomy，OPLC)的可行性和可能性在国内还未广泛认同。此项连续前瞻性研究探讨门诊腹腔镜胆囊切除是否安全、经济而具可行性。方法：共有55位经选择患者加入此项研究。其中门诊腹腔镜组(OPLC)26位，术后院内观察6-8小时后返家;常规腹腔镜组(LC)29位，术后住院超过24小时。手术由同一组医生施行，手术麻醉均采用硬膜外麻醉。OPLC患者出院前必须详细检查确认，出院后由家属看护，一旦出现问题可立即再入院。术前检查、诊断以及术后留院时间、花费和并发症的资料采集后，予“独立样本T检验”(SPSS 10.0统计软件)进行分析。结果：所有患者没有中转开腹手术。OPLC患者术后没有发生严一重并发症如CBD损伤、出血等，仅一例OPLC患者术后因严重的恶。G呕吐而要求再入院。0巩C患者平均术后观察时间为7．1卜小时，平均总j台疗费用为 4108．73 RMB，较u 患者的 5068．17 RMB 降低有极显著差异（t＝31．“4，p＜0．O01）。25／26位OPLC 患者对这种治疗方案表示满意，与＊组患者满意度门 8八 9）无统计学差异（Chi square test：产0．4131，P＞0．05）。结论：两组手术效果相同。两组患者和家属均对治疗结果表示满意。n统计结果来看，对于经选择病人 OPLC和住院u同样安全，而总治疗费用更低。

关键词： Laparoscopic Cholecystectomy outpatient surgery Length of Stay Cost analysis Patient Satisfaction