急诊日间手术发展现状与管理流程的系统评价

A systematic review on development history and management of ambulatory emergency surgery

目的 系统分析急诊日间手术发展现状,总结其管理流程和优势。方法 检索PubMed、Web of Science、万方数据、中国知网、中国生物医学文献数据库、维普数据库,纳入研究主题涉及急诊日间手术的发展现状、管理流程及其效果评估等文献,检索时限均为建库至2023-07-16。纳入研究按照急诊日间手术的种类、性质、手术级别、涉及专科、结局指标、治疗费用等进行描述性分析。结果 最终纳入9篇研究,其中6篇为前瞻性研究,3篇为回顾性研究,且开展研究的国家主要为法国、美国、英国等发达国家;涵盖疾病主要为急性胆囊炎、急性胆结石、嵌顿疝、急性阑尾炎、急性囊肿、脓肿、急性非特异性腹痛等;评价指标包括病人就诊等待时间、平均住院时间、术后并发症、术后再入院率、治疗费用及病人满意度等。现有研究结果表明急诊日间手术病人诊疗相关时间和经济成本均较常规急诊手术有所降低。结论 急诊日间手术作为一种新型急诊手术管理模式,尚处于发展初步阶段,其在降低病人治疗时间成本和医疗花费等方面具有潜在的优势。

Objective Ambulatory emergency surgery(AES)has been carried out gradually in developed countries but less in China.The study systematically summarized the developmental history and management of AES around the world to provide references for the performance of AES in China.Methods PubMed,Web of Science,Wanfang,CBM Database,and VIP Database were searched with the words"emergency ambulatory surgery",which the search time was limited on July 16,2023.The included studies included the development history,management,and evaluation of AES.Descriptive analysis was conducted on procedure types,operation levels,specialties,research outcomes,and costs.Results Nine studies were ultimately included.Of them,six studies(66.7%)were prospective.In contrast,three(33.3%)were retrospective studies,which were contributed from the developed countries in Europe and America,such as France,the United States,and Britain.Meanwhile,the main diseases covered were acute cholecystitis,acute gallstones,incarcerated hernia,acute appendicitis,acute cysts,etc.Besides,the assessment outcomes include the waiting time,average hospitalization time,postoperative complications,postoperative readmission rate,treatment cost,and patient satisfaction,etc.The results concluded that the spent time and the price have been reduced since the performance of AES.Conclusion As a new emergency management mode,AES is still in the initial stage of development,it has potential advantages in reducing the time and the cost of disease treatment.