Analysis of the disease entities and typical characteristics of day surgery based on three Public Tertiary A hospitals in China

Background:In recent years,day surgery has gained widespread attention in the medical industry.This thesis focuses on three tertiary general hospitals in different regions in China where day surgery has been carried out earlier,is more developed,has a more comprehensive range of day surgery procedures,and has an annual volume of 10,000 or more day surgery cases.The study will provide hands-on experience for other medical institutions to carry out day surgery.Methods:67,337 valid items of data were retrieved from the Hospital Information Systems of the three hospitals.In this thesis,descriptive analysis was carried out on basic information about day surgery patients,including composition of patients’major diseases,hospitalization costs.Non-parametric tests were used to compare the data in each group,the median and interquartile range were used to show the trend in the concentration of the relevant indicators.The difference was considered statistically significant at P<0.05.Results:The largest proportion of day surgery patients were between the ages of 51 and 70.About 57.30%of day surgery patients paid for their medical care with the basic medical insurance of urban employees.Senile cataract,benign breast tumor,and endometrial polyp were the top three major diagnoses of day surgery patients.The average inpatient expenditure for day surgery patients was 8982.10 yuan,with consumables cost representing the highest proportion at approximately 46.01%of the total hospitalization cost,followed by treatment cost at around 31.01%of the total cost.Conclusions:Day surgery is more suitable for middle-aged patients and may not be the best choice for children and elderly patients over 80 years old.Most day surgery cases are elective surgeries for non-emergency situations.The distribution of day surgery patients is primarily concentrated in ophthalmic,breast,and reproductive system diseases,although each hospital has its own unique characteristics.The development of day surgery presents both economic and social benefits.

Explore the clinical nursing path of daytime laparoscopic cholecystectomy under the guidance of enhanced recovery after surgery

Objective:To explore the safety and effectiveness nursing of 12 h discharged daytime laparoscopic cholecystectomy guided by enhanced recovery after surgery(ERAS)concept.Methods:Included 180 cases from the 12 h discharged daytime laparoscopic cholecystectomy patients which assessmended and guided by ERAS,with the 180 case of routine cholecystectomy patients as control group at the same time.To quantitatively analyze the related indexes of perioperative period and ERAS concept,and evaluate the clinical safety,and effectiveness.Results:It displayed no significant differences in average age,gender distribution,duration of gallbladder related disease and distribution of clinical symptoms between the two groups(P>0.05).There were also no significant differences in preoperative smoking history,hypertension history,cardio-cerebrovascular history,abdominal operation history and disease composition ratio between the two groups(P>0.05).None of the patients had conversion to laparotomy.Compared with the conventional surgery group,there were no significant differences in the average amount of intraoperative blood loss,operation time and muscle strength before returning to the ward in patients with ERAS guided day surgery(P>0.05).When compared with the conventional surgery group,ERAS guided day surgery group had no significant difference in muscle strength between the two groups when going under the ground(t=1.64,P=0.082).Also,the level of peripheral white blood cells in patients with ERAS guided day surgery group was not significantly increased at 6 h after surgery.Meanwhile,liver function related indexes,transaminase,total bilirubin,indirect bilirubin were not significantly abnormal(P>0.05).Conclusion:12 h daytime laparoscopic cholecystectomy guided by ERAS concept can improve the clinical efficacy of patients with cholecystolithiasis,which is safe and feasible.

Application of Whole-Process Management in Day Surgery for Endometrial Polyp

Objective:To explore the effect of whole-process management model in nursing management of endometrial polyp day surgery.Methods:266 patients that underwent endometrial polyp day surgery from January to December 2022 were selected for this study,and they were separated into an observation group(131 patients)and a control group(135 patients);the clinical data of the two groups were compared.Results:After intervention,the scores of Hamilton Anxiety Scale(HAM-A)of the patients in the observation group were lower than those in the control group(P<0.05).The rate of postoperative complications in the observation group was lower than that in the control group(P<0.05),and the satisfaction degree of the patients in the observation group was higher than that in the control group(P<0.05).Conclusion:The application of the whole-course management model in endometrial polyp day surgery can alleviate patients’anxiety,ensure the quality and safety of day surgery nursing,and improve patients’satisfaction.

Day-of-surgery rejection of donors in living donor liver transplantation

AIM: To study diagnostic laparoscopy as a tool for excluding donors on the day of surgery in living donor liver transplantation (LDLT).METHODS: This study analyzed prospectively collected data from all potential donors for LDLT. All of the donors were subjected to a three-step donor evaluation protocol at our institution. Step one consisted of a clinical and social evaluation, including a liver profile, hepatitis markers, a renal profile, a complete blood count, and an abdominal ultrasound with Doppler. Step two involved tests to exclude liver diseases and to evaluate the donor’s serological status. This step also included a radiological evaluation of the biliary anatomy and liver vascular anatomy using magnetic resonance cholan-giopanc reatography and a computed tomography (CT) angiogram, respectively. A CT volumetric study was used to calculate the volume of the liver parenchyma. Step three included an ultrasound-guided liver biopsy. Between November 2002 and May 2009, sixty-nine potential living donors were assessed by open exploration prior to harvesting the planned part of the liver. Between the end of May 2009 and October 2010, 30 potential living donors were assessed laparoscopically to determine whether to proceed with the abdominal incision to harvest part of the liver for donation. RESULTS: Ninety-nine living donor liver transplants were attempted at our center between November 2002 and October 2010. Twelve of these procedures were aborted on the day of surgery (12.1%) due to donor findings, and eighty-seven were completed (87.9%). These 87 liver transplants were divided into the following groups: Group A, which included 65 transplants that were performed between November 2002 and May 2009, and Group B, which included 22 transplants that were performed between the end of May 2009 and October 2010. The demographic data for the two groups of donors were found to match; moreover, no significant difference was observed between the two groups of donors with respect to hospital stay, nar-cotic and non-narcotic analgesia requirements or the incidence of complications. Regarding the recipients, our study clearly revealed that there was no significant difference in either the incidence of different complications or the incidence of retransplantation between the two groups. Day-of-surgery donor assessment for LDLT procedures at our center has passed through two eras,open and laparoscopic. In the first era, sixty-nine LDLT procedures were attempted between November 2002 and May 2009. Upon open exploration of the donors on the day of surgery, sixty-five donors were found to have livers with a grossly normal appearance. Four donors out of 69 (5.7%) were rejected on the day of surgery because their livers were grossly fatty and pale. In the laparoscopic era, thirty LDLT procedures were attempted between the end of May 2009 and October 2010. After the laparoscopic assessment on the day of surgery, twenty-two transplantation procedures were completed (73.4%), and eight were aborted (26.6%). Our data showed that the levels of steatosis in the rejected donors were in the acceptable range. Moreover, the results of the liver biopsies of rejected donors were comparable between the group A and group B donors. The laparoscopic assessment of donors presents many advantages relative to the assessment of donors through open exploration; in particular, the laparo-scopic assessment causes less pain, requires a shorter hospital stay and leads to far superior cosmetic results. CONCLUSION: The laparoscopic assessment of donors in LDLT is a safe and acceptable procedure that avoids unnecessary large abdominal incisions and increases the chance of achieving donor safety.

THIRTY YEARS IN SKULL BASE SURGERY

The skull base generally refers to the anterior, middle and posterior cranial fossa and structures on the outside side of these skull areas. The cranial roof and skull base are separated by a line connecting the external occipital protuberance, parietal notch and supraorbital ridge[1].The skull base supports the brain above, is connected to

Nursing Care of 13 Cases with Acute Retinal Necrosis Associated with HIV/AIDS during Day Surgery

Objective: Summarizing the nursing points from the treatment of the 13 cases of AIDS-related acute retinal necrosis syndrome (ARNS). Methods: Retrospective analysis of clinical nursing process of 13 cases (15 eyes) of AIDS-related ARNS patient treated in our hospital from January to December 2019. Results: The retina of all the patients were flat after operation. Postoperative visual acuity: bilateral visual acuity < 0.05 in 3 cases, >0.1 in 11 eyes, 0.01 - 0.1 in 3 eyes, >0.1 in 1 eye. No adverse events and nursing safety events occurred. Patients recovered well after operation during the follow-up after discharge. Conclusion: The focus of nursing care for patients with HIV/AIDS combined with acute retinal necrosis during daytime surgery is multifaceted, apart from the daily, perioperative nursing in day-care unit, continuous nursing, psychological counseling, disinfection and isolation should be paid attention to. At the same time, with the help of promotion and application of information education means, the treatment compliance of patients can be improved, which plays an essential role in the advance of the treatment effect.

Day surgery in strabismus operation under general anesthesia

Background:The purpose of this study is to summarize the application of day surgery combined with fast track program in strabismus operation under general anesthesia.Methods:The clinical data of 2,000 cases of strabismus patients who had underwent surgery in day surgery or traditional hospitalization in the duration from 2015 to 2016 was retrospectively analyzed.The safety and efficacy were assessed by comparing the average length of stay in hospitals,anesthesia recovery time,patient satisfaction and number of adverse events.Results:Compared with the traditional group,the average length of stay in hospital and recovery time in day surgery group were significantly lower(P<0.001)and the satisfaction of patient was improved(P<0.05),which were statistically significant difference.Moreover,no adverse events occurred among these patients.Conclusions:The application of day surgery in strabismus operation under general anesthesia is feasible,which can reduce the recovery time and shorten the hospital stay of patients safely and effectively,and their satisfaction was improved at the same time.

Effects of multimodal fast-track surgery on liver transplantation outcomes

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation. METHODS: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraoperative blood loss, and intraoperative blood transfusion volume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postoperative complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting prognosis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.

Can Simple Preoperative Hemoglobin Testing Screen Symptomatic Anemia in Patients Undergoing Ambulatory Surgeries in Third World Countries?

Background: Patients coming for ambulatory surgeries are mostly healthy adults and asymptomatic anemia in these patients is rare. According to international standards, perioperative period is not an appropriate setting to screen and investigate the cause of asymptomatic anemia, but in third world countries where iron deficiency is rampant, it is generally required as per local hospitals policy to test hemoglobin levels prior to any surgery in order to prevent morbidity. The purpose of our study is to look at the prevalence of anemia in patient undergoing minor elective ambulatory surgeries. Method: This was a cross sectional observational study conducted at tertiary care unit, Karachi, Pakistan. A total of 385 ASA-I (American Society of Anesthesiologist) and II patient’s age ranged 18 - 60 years, scheduled for day care surgical procedures were enrolled in the study. Results: Anemia was detected in 74 (19.2%) patients and its prevalence was found to be higher in females and in patients above 50 years of age. However, the presence of anemia did not have any influence on the perioperative outcomes or management. Conclusion: The routine preoperative hemoglobin testing does not have any effect on the perioperative outcomes in asymptomatic patients who are planned for elective day care surgeries.

Thirty Days in America

At the invitation of the Center for Foreign Journalists (CFJ) in America, seven other Chinese women journalists and I attended a monthlong work/study program in the United States that focused on women and development. The program was organized and administered by CFJ and was carried out in Washington D.C., New York and San Francisco. The head of our delegation was Chen Xiuxia, the vice-chairwoman of the All-China Journalist’s Association Subcommission for Communication. The six other members were representatives of major national newspapers based in Beijing. They were: Chen Yi from Economics Daily, Hu Shuli from China Business Times, Li Xing from China Daily, Mu Ya from People’s Daily, Wang Weiqun from China Youth Daily and Xiong Lei from Xinhua News Agency.

下肢骨折病人术后35天内深静脉血栓的发生情况及危险因素分析

目的探讨下肢骨折病人出院后35 d内深静脉血栓形成(deep vein thrombosis,DVT)的发生率及危险因素。方法回顾性分析2014年7月至2017年7月西安交通大学医学院附属红会医院创伤骨科收治的402例住院期间未发生DVT的下肢骨折病人的临床资料。所有病人术前、术后都常规用物理方法和药物抗凝预防DVT,嘱咐病人出院后口服利伐沙班抗凝至术后35 d,记录术后35 d复查时双下肢DVT的发生情况。根据术后35 d门诊复查双下肢超声结果将病人分为DVT组和非DVT组,分析比较两组病人的性别、年龄、骨折部位、身体质量指数、合并其他骨折、合并内科疾病、术后的实验室检查(D-二聚体)、术后住院时间的差异,对上诉结果中差异有统计学意义的变量进一步采用多因素Logistic回归分析,分析病人出院后DVT的危险因素。结果402例下肢骨折病人出院后发生DVT的有56例(13.9%),其中2例(0.50%)发生肺栓塞,2例均合并有小腿肌间静脉血栓,1例发生在术后3周,1例在术后4周发生致死性肺栓塞。周围型52例,单纯中央型0例,混合型4例。膝关节以近的骨折病人DVT发生率为15.5%(36/232),膝关节周围骨折病人DVT发生率为13.8%(8/58),膝关节以远骨折病人DVT发生率10.7%(12/112)。两组间年龄、合并其他骨折、术后住院时间、冠心病、术后1 d D-二聚体、出院时D-二聚体的差异有统计学意义(P<0.05),多因素Logistic回归分析显示年龄>60岁[OR=3.207,95%CI(2.007,8.553),P=0.009]、合并其他骨折[OR=7.111,95%CI(2.297,22.011),P<0.001]、术后住院时间<7 d[OR=1.448,95%CI(1.225,1.718),P=0.020]、出院时D-二聚体偏高[OR=1.355,95%CI(0.892,12.626),P=0.027]是出院后DVT的独立危险因素。结论虽然出院前常规使用物理方法和药物抗凝预防DVT,出院后嘱咐病人口服利伐沙班35 d,但是出院时没有DVT的下肢骨折病人术后35 d仍有发生DVT的可能(13.9%),严重者还会发生肺栓塞,年龄、合并其他骨折、术后住院时间较短、出院时D-二聚体是出院后DVT发生的独立危险因素。

Current trends in laparoscopic groin hernia repair: A review

Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A Pub Med and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available.

VAB and MRI Following Percutaneous Ultra-Sound Guided Cryoablation for Primary Early-Stage Breast Cancer: A Pilot Study in Japan

Objective: This study aimed to evaluate the feasibility, safety, and cosmetic outcomes of percutaneous cryoablation (PCA) of breast intraductal carcinoma (IDC) lesions, as well as post-cryoablation magnetic resonance imaging (MRI) as a follow-up tool for detection of residual malignancies and local recurrences. Methods: Eight female patients underwent percutaneous ultrasound-guided cryoablation of breast IDC tumors under local anesthesia without subsequent resection. All patients received radiation- and endocrine therapies (RT, ET). The patients were followed using vacuum-assisted biopsy (VAB), mammography (MG), magnetic resonance imaging (MRI), and Moiré Topography for cosmetic outcomes. VAB was performed 6 months following cryoablation treatment for cases 1 and 2 (after starting radiation- and endocrine-therapies) or one month after PCA (cases 3, 4, 5, 6 and 7), prior to RT and ET. One patient declined VAB. Results: Mean age of the patients was 61.9 years, SD 7.7, ages range 53 - 72 years. Mean tumor size was 10.3 mm, SD 2.74, ranged 6.8 - 14.5 mm, median follow-up time was 28 months (range 13 - 34 months). No residual or recurrent malignancies were detected. One minor adverse event was observed: A skin redness in the ablated area;MRI at one-month post-cryotherapy showed various degrees of thermal burns in all patients in the pectoralis major muscle, which were not symptomatic and were resolved by 6 months following PCA. Decrease of fat necrosis areas in the vicinity of ablated ex-tumor was traced with MRI (mean size 54.9 mm, mean decrease after 2 years was 58%) and validated with VAB. Conclusions: Percutaneous cryoablation of early-stage low-risk breast cancer tumors smaller than 15 mm potentially presents a potential substitute for lumpectomy, offering encouraging short- to mid-term oncology results with good cosmesis outcomes. Patients would be able to benefit from local anesthesia in an outpatient setting and a shorter recovery period.