Campos CC, Hurtado LLM, Basurto KE, Zaldívar RR

Language: Spanish
References: 16
Page: 130-133
PDF size: 57.18 Kb.

ABSTRACT

Objective: To demonstrate the benefits of the impact, time, and cost-effectiveness of short stay surgery performed on weekends and holidays.
Setting: General Hospital of Mexico (Third level health care hospital).
Design: Prospective, cross-sectional, observational, and comparative study.
Statistical analysis: Student’s t test, chi square, and cost-effectiveness analysis.
Material and method: During 4 years, 1,200 surgeries were performed within this pilot program, using the installed hospital infrastructure and the same personnel employed for medical care in those days, without having a special short stay surgery unit as such. Performed procedures were: inguinal plasty, resection of pilonidal disease, umbilical plasty, resection of benign soft tissue tumor, wall plasty, subcutaneous mastectomy, hemorrhoidectomy, fistulectomy, and excision of benign breast tumors, these were compared with the same procedures but performed as programmed surgeries. We assessed and compared the following variables: age, gender, performed procedure, time of hospital stay, and cost-benefit of the procedure. We also evaluated the need of hospitalization, re-admittance in less than 24 h, morbidity and mortality.
Results: Diagnoses included: inguinal hernias with 486 cases, 359 cases of soft tissue tumors, 185 cases of umbilical hernia, 88 cases of eventration, 22 cases of anorectal disease, 17 cases of pilonidal disease, 17 cases of gynecomastia, 10 cases of phimosis, and 11 other diagnoses. We performed inguinal plasties, resection of pilonidal disease, umbilical plasty, excision of soft tissue tumor, wall plasty, subcutaneous mastectomy, hemorrhoidectomy and/or fistulectomy, circumcision and other procedures. The time used for surgical management was reduced from an average of 36 to 12 hours (p ‹ 0.05). Cost-effectiveness was 40% lower as compared with the traditional method. Surgical and anesthetic times were not different between ambulatory and traditional surgeries.
Conclusion: Short stay surgery can be performed efficiently on the weekends and holydays with a 40% savings.

REFERENCES

1. Davis JE. Ambulatory surgery ... how far can we go? Med Clin North Am 1993; 77: 365-375.

2. Morris D, Ward AW, Handyside AJ. Early discharge after hernia repair. Lancet 1968; 1: 681-685.

3. Alvarado GFJ, Vega SE. La cirugía ambulatoria, una opción para mejorar la calidad de la atención. Experiencia de 15 años. Rev Esp Med Quir 2006; 11: 34-37.

4. Gutiérrez R, Leopoldo S. Experiencia en 250 colecistectomías por laparoscopia. Cir Cir 1994; 61: 10-18.

5. Marron PGM, Cañas HMA, Ríos BBR, Araujo NM, Villegas MG. Conceptos fundamentales sobre anestesia en cirugía ambulatoria. Rev Mex Anest 1995; 18: 137-144.

6. Vinoles J, Ibanez MV, Ayala G. Predicting recovery at home after ambulatory surgery. BMC Health Serv Res 2011; 11: 269.

7. Ozgen H, Ozcan YA. A national study of efficiency for dialysis centers: an examination of market competition and facility characteristics for production of multiple dialysis outputs. Health Serv Res 2002; 37: 711-732.

8. Plotzke MR, Courtemanche C. Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital? Health Econ 2011; 20: 817-830.

9. Hollenbeck BK, Hollingsworth JM, Dunn RL, Zaojun Ye, Birkmeyer JD. Ambulatory surgery center market share and rates of outpatient surgery in the elderly. Surg Innov 2010; 17: 340-345.

10. Carey K, Burgess JF Jr, Young GJ. Hospital competition and financial performance: the effects of ambulatory surgery centers. Health Econ 2011; 20: 571-581.

11. Abdallah FW, Brull R. Making sense of block “success” in ambulatory anesthesia practice. Int Anesthesiol Clin 2011; 49: 1-9.

12. Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 2005; 101: 1634-1642.

13. Jacob AK, Walsh MT, Dilger JA. Role of regional anesthesia in the ambulatory environment. Anesthesiol Clin 2010; 28: 251-266.

14. Baldó X, Sebastián F, Rubio M, Martínez S, Haro M, Álvarez L. Análisis de los resultados del Programa de Corta Estancia en Cirugía Torácica en el periodo 2001-2005. Cir Esp 2007; 81: 335-338.

15. Tovar EA. One-day admission for major lung resections in septuagenarians and octogenarians: a comparative study with a younger cohort. Eur J Cardiothorac Surg 2001; 20: 449-454.

16. Mezei G, Chung F. Return hospital visits and hospital readmissions after ambulatory surgery. Ann Surg 1999; 230: 721-727.