UCMA ginecológica: experiencia de 10 años / Gynaecological ambulatory surgery: 10 years experience

RESUMEN

INTRODUCCIÓN: Nuestro hospital dispone de una Unidad de Cirugía Mayor Ambulatoria (UCMA) autónoma, integrada al mismo, con la que comparte el área quirúrgica. Ginecología se incorporó a la UCMA en julio de 1994 y tras 10 años de actividad, habiendo sobrepasado las 1.000 intervenciones, hemos creido oportuno revisar y presentar nuestra casuística, con las nuevas indicaciones y las que hemos abandonado. Comentamos las posibilidades futuras de nuestra especialidad en Cirugía Mayor Ambulatoria (cma). MATERIAL y Métodos. Efectuamos un estudio retrospectivo de nuestra experiencia durante 10 años (julio 1994 – junio 2004). Exponemos las indicaciones y su evolución. Efectuamos el control de calidad mediante los ingresos inmediatos y diferidos, anulaciones y llamadas telefónicas. Analizamos las repercusiones de la UCMA sobre nuestra actividad quirúrgica general y sobre la productividad. RSULTADOS Durante este período efectuamos 4.369 intervenciones, 1.141 (26%) en la UCMA. El Servicio de Ginecología participó con el 7% en la actividad total de la UCMA, que recibió durante este período 16.513 pacientes. Las intervenciones más frecuentes fueron histerosocpia de flujo (47,5%), laparoscopia (19,5%) y cirugía mamaria (14%). Hemos dejado de efectuar el legrado uterino. Iniciamos la minilaparosocpia para la (..) (AU)

ABSTRACT

INTRODUCTION: Our hospital has an autonomous Ambulatory Surgical (ASU) which is into the main building and shares the Surgical Area with the rest of the hospital. The Department of Gynaecology was incorporated into this ASU in July 1994. After ten years of activity and having done over 1,000 operations, we have thought fit to review and present our case history, with the new procedures that have been included and those that were abandoned. We will comment onthe future possibilities of our speciality in Ambulatory Surgery (AS). MATERIAL AND METHODS: we carried out a retrospective study of our experience over 10 years (July 1994 – Jun 2004). We described the surgical indications and their evolution. The control of quality was evaluated by means of the most significant indicators immediate hospital admission, delayed re-admissions, cancellations and phone calls to the ASU. We analyzed the influence of its activity on our general surgical activity and productivity. RESULTS: Over these 10 years we have carried out 4,369 gynaecological procedures, 1,141 (26%) of them were performed in the ASU. The Gynaecological Department took part with 7% of the total activity of the ASU, where 16,513 patients from all the surgical specialities were received. The most frequent procedures were hysteroscopy (47.5%), laparosocpy (19.5%) and breast surgery (14%). We stopped doing uterine curettage. We recently started mini-laparosocpy for tubal occlusion, under local anesthesia and sedation, in 26 patients; we have increased the surgical indications for laparoscopy for treatment of adnexal pathology. In breast surgery, 3 cases of sentinel node biopsy were included, we decreased the number of biopsies of non-palpable lesions, previously marked with a needle. We started to perform vaginal hysterectomy at the end of this series. We had 37 (3.2%) immediate admissions, 5 (0.4%) delayed re-admissions, 10 (0.9%) cancellations and 138 (12%) telephone calls. During this time, we have improved our Ambulatory Surgery and Office Surgery activites, with the consequent increase inproductivity. DISCUSSION: Our speciality has great possibilities in AS. We have updated some resources procedures (Le Font operation and Manchester Operation), included some new techniques (continous flow histeroscopy, mini-laparoscopy, sentinel node biopsy), and we have abandoned some others (uterine curettage, breast biopsy with needle localization). Our Quality controls are appropriated, and we have increases our surgical productivity,. In the future. We want to add hysterosocpic tubal occlusion and the treatment of urinary stress incontinence with tension-free vaginal tape (TVT) to our surgical indications (AU)