Results of a major ambulatory oral surgery program using generalinhalational anesthesia on disabled patients

Objectives: To assess the demographic characteristics and comorbidities of the group to be studied, as well as variousquality indicators of a Major Ambulatory Surgery (MAS) program. Quantification of the surgical-anestheticincidents. Study design: We aimed to perform a retrospective and descriptive analysis of disabled patients who hadreceived oral ambulatory surgery under general anesthesia. Data obtained from the clinical history and telephoneinterview included the demographic characteristics, socioeconomic status, previous dental history, cause of themental disability, degree of mental retardation, comorbidity measured according to the scale of the AmericanSociety of Anesthesiologists (ASA), anesthesia or preoperative surgical treatments, level of analgesia, length ofstay, incidents in the Resuscitation Ward, the rate of substitution, suspensions, patients admitted, complicationsand the degree of patient satisfaction. Results: We included 112 oral surgery procedures performed on disabledpatients who were treated under general inhalational anesthesia as part of MAS during the years 2006-2007. Duringthis period, 577 restorations, 413 extractions, 179 sealants, 102 pulpectomies, 22 root canal treatments, 17gingivectomies and 3 frenectomies were performed. A total of 75% (78 cases) of the patients had coexisting medicalpathology. The average surgery time per patient was 72.69 ±29.78 minutes. The rate of replacement was 100%.The rate of suspension was 1.92%. The percentage of patients readmitted was 1.92%,due to significant bleedingin the mouth, which did not require treatment and the patients were discharged from hospital 24 hours after beingadmitted. The rate of patients who required re-hospitalization was 3.84%. Conclusions: The MAS performed inthis group, despite being on patients with high comorbidity resulted in only a low number of medical incidentsreported (AU)

Results of a major ambulatory oral surgery program using general inhalational anesthesia on disabled patients.

OBJECTIVES: To assess the demographic characteristics and comorbidities of the group to be studied, as well as various quality indicators of a Major Ambulatory Surgery (MAS) program. Quantification of the surgical-anesthetic incidents. STUDY DESIGN: We aimed to perform a retrospective and descriptive analysis of disabled patients who had received oral ambulatory surgery under general anesthesia. Data obtained from the clinical history and telephone interview included the demographic characteristics, socioeconomic status, previous dental history, cause of the mental disability, degree of mental retardation, comorbidity measured according to the scale of the American Society of Anesthesiologists (ASA), anesthesia or preoperative surgical treatments, level of analgesia, length of stay, incidents in the Resuscitation Ward, the rate of substitution, suspensions, patients admitted, complications and the degree of patient satisfaction. RESULTS: We included 112 oral surgery procedures performed on disabled patients who were treated under general inhalational anesthesia as part of MAS during the years 2006-2007. During this period, 577 restorations, 413 extractions, 179 sealants, 102 pulpectomies, 22 root canal treatments, 17 gingivectomies and 3 frenectomies were performed. A total of 75% (78 cases) of the patients had coexisting medical pathology. The average surgery time per patient was 72.69 +/- 29.78 minutes. The rate of replacement was 100%. The rate of suspension was 1.92%. The percentage of patients readmitted was 1.92%,due to significant bleeding in the mouth, which did not require treatment and the patients were discharged from hospital 24 hours after being admitted. The rate of patients who required re-hospitalization was 3.84%. CONCLUSIONS: The MAS performed in this group, despite being on patients with high comorbidity resulted in only a low number of medical incidents reported.

Resultados de un programa de cirugía mayor ambulatoria en ginecología / Results of an ambulatory surgery program in gynecology

Objetivo: Evaluar los resultados de un programa de cirugía mayor ambulatoria (CMA) en ginecología. Material y métodos: Estudio retrospectivo del período 2002-2006. Las intervenciones incluidas fueron histeroscopias quirúrgicas y esterilizaciones tubáricas laparoscópicas. Se han analizado diversos indicadores de calidad (índice de sustitución, suspensión, ingresos, reingresos) y las complicaciones sistémicas y quirúrgicas que surgieron dentro de la primera semana tras la cirugía. Resultados: Mil doscientos catorce pacientes fueron intervenidos por el Servicio de Ginecología en el período indicado, con un índice de sustitución global del 90%. El índice de ingresos tras la cirugía fue 1,15%. Diez pacientes presentaron complicaciones graves, lo que representa un riesgo proporcional de 1:121. En 35 pacientes aparecieron complicaciones de menor gravedad que requirieron su ingreso hospitalario. Las complicaciones ginecológicas graves ocurrieron en 2 casos. Conclusiones: A pesar del cumplimiento de los requisitos óptimos, existe un porcentaje pequeño de complicaciones postoperatorias de gravedad variable (AU)

Objective: To evaluate the outcomes of an ambulatory surgery program in gynecological diseases. Material and methods: We performed a retrospective study of patients who underwent surgical hysteroscopy or laparoscopic tubal sterilization from January 2002 to December 2006. Several quality indicators (substitution, cancellation, admission and readmission rates) and the systemic and surgical complications appearing in the first week after surgery were analyzed. Results: During the study period, 1,214 patients underwent surgery in the gynecology service, with a global substitution rate of 90%. The admission rate after surgery was 1.15%. Severe complications occurred in 10 patients, representing a proportional risk of 1:121. Less severe complications requiring hospital admission occurred in 35 patients. Severe gynecological complications occurred in 2 patients. Conclusions: Despite compliance with optimal requirements, there was a low rate of postoperative complications of variable severity (AU)

[Ambulatory surgery in a urology department. Analysis of the period 2003-2006]. / Cirugía ambulatoria en un Servicio de Urología. Análisis del período 2003-2006.

OBJECTIVES: When talking about day surgery we have to differentiate between minor and major ambulatory surgery. Ambulatory surgery enables the patient to stay in the hospital not more than a few hours, showing similar safety and efficacy than conventional surgery. The objective of this paper is to evaluate the results of an ambulatory surgery program. METHODS: Descriptive retrospective study of the results of the Ambulatory Surgery in a Urology Department, including 4,185 patients in a four-year period, from January 1st 2003 to December 31st 2006. RESULTS: In the study period the global substitution rate was 83.6%. The hospital admission rate was 2.5%, most of which were early admissions. Major complications appeared in 26 patients (0.6%), being major bleeding the predominant one. Most complications were minor or mild, and pain at the site of the surgical wound was the most frequent problem found. CONCLUSIONS: The increase and continuous promotion of ambulatory surgery are more than justified. The high satisfaction among patients undergoing this type of surgery, with a very low number of complications registered, provides us with a valuable tool for health-care expenditure control.

Análisis de los reingresos hospitalarios domiciliarios en un programa de cirugía mayor ambulatoria / Analysis of outpatients readmitted to an ambulatory surgery program

Objetivos. Cuantificar las tasas de reingresos por complicaciones mayores y menores por años de estudio de un programa de cirugía mayor ambulatoria (CMA) y evaluar la inclusión de pacientes con un estado basal más deteriorado en los resultados. Pacientes y método. Estudio retrospectivo de los pacientes intervenidos en un programa de CMA en nuestro centro durante el período de 1998-2003. En el período de estudio citado se intervino de forma programada y con criterios de selección de CMA a un total de 25.553 pacientes. Para analizar la evolución de las complicaciones en el período de estudio, utilizamos la prueba de la χ² de tendencias, en la que se obtuvieron odds ratio anuales y sus intervalos de confianza teniendo como referencia el primer año del estudio. Resultados. El índice de sustitución en el período de estudio fue del 55,25%. El riesgo proporcional de tener una complicación mayor en nuestra serie es de 1:426. El total de pacientes con reingreso hospitalario procedente de su domicilio representa 0,83% del total de pacientes intervenidos en régimen de CMA. La causa más común de reingreso hospitalario en el presente trabajo son los factores quirúrgicos, principalmente la hemorragia del lecho quirúrgico. La mayoría de las complicaciones son menores o leves, y el dolor en la zona de la herida quirúrgica es el problema encontrado con más frecuencia. Conclusiones. La seguridad es una actitud y cuando se siguen buenos principios de selección del paciente por el cirujano y anestesiólogo, con evaluación preanestésica cuidadosa, no hay motivo para esperar más complicaciones que en pacientes hospitalizados (AU)

Objectives. To quantify readmission rates due to both major and minor complications per year of study in an ambulatory surgery program and to assess the effect of including patients with greater severity on the results. Patients and method. We performed a retrospective study of patients undergoing surgery in an ambulatory surgery program in our health center between 1998 and 2003. During the study period, 25,553 patients met the selection criteria for elective ambulatory surgery. To analyze the evolution of complications over the study period, the first year of the study period was taken as the reference, and the χ² test was used to measure tendency, obtaining annual odd ratios (OR) and their respective confidence intervals. Results. The substitution index in the study period was 55.25%. The proportional risk of a major complication in our series was 1:426. The number of patients readmitted from home represented 0.83% of the total number of patients undergoing ambulatory surgery. The most common causes of readmission were surgically-related occurrences, mainly bleeding from the surgical site. Most complications were minor, the most frequently found problem being pain in the surgical wound. Conclusions. Safety is an attitude and when the surgeon and the anesthesiologist apply appropriate patient selection criteria and perform a careful preanesthesia evaluation, there is no reason to expect more complications in ambulatory patients than in inpatients (AU)