小儿日间手术集中管理模式探讨

Perioperative management of pediatric ambulatory surgery

目的探讨适合我国国情的小儿日间手术管理模式。方法介绍广州市妇女儿童医疗中心运行的以麻醉医生为主导的日间手术围术期集中管理方案。回顾与分析该院2016~2019年50042例日间手术的开展情况:包括患儿一般情况、日间手术数量及比例、手术取消(改期)率、术前等待时间、术后留观时间、总住院时间、非计划再次手术和术后随访情况等。结果2016~2019年小儿日间年手术量从5124例增加到17308例,日间手术比例从23.1%增加到51.1%。2019年日间手术住院时间为(335±78)min,术前等待时间为(169±84)min,术后留观时间为(136±52)min,手术爽约率为7.6%,当日手术取消率为2.1%,术后延迟出院率(术后留观时间>5 h)为0.4%,非计划入院率为0.05%;非计划再次手术率为0.03%;术后第一、三、七天随访率分别为86.9%、75.4%和69.4%;术后发热与疼痛发生率分别为19.2%与36.1%。结论建立以麻醉医生为主导的日间手术中心有利于日间手术安全高效的开展。引入互联网社交平台能有助于患儿及家属的健康教育和术后随访。

Objective To explore the appropriate perioperative management of pediatric ambulatory surgery in China.Methods The protocol of pediatric ambulatory surgery was reviewed.From 2016 to 2019,clinical data were retrospectively analyzed for 50042 ambulatory surgeries,including patient demographics,number/rate of ambulatory surgery,length of hospitalization stay,rate of surgery cancellation,unplanned reoperation and outcome of postoperative follow-up.Results The number and percentage of ambulatory surgery increased from 5124(23.1%)to 17308(51.1%).In 2019,length of hospitalization stay,preoperative waiting time and postoperative care time was(335±78),(169±84)and(136±52)min;rate of total surgery cancellation 7.6%,rate of last-minute cancellation 2.1%,rate of delayed discharge(postoperative care time>5 h)0.4%,rate of unanticipated admission 0.05%;rate of unplanned reoperation 0.03%.And the rate of follow-up was 86.9%,75.4%and 69.4%at Day 1/3/7 post-operation.Respectively 19.2%and 36.1%of children reported fever and pain after discharge.Conclusions Ambulatory surgery may be performed efficiently and safely at a dedicated ambulatory surgical center managed by anesthesiologists.Social networking platform is both feasible and potentially effective for patient counseling and follow-ups.