The aim of the study was to evaluate the acceptability of CO2 laser excisional conization for cervical intraepithelial neoplasia under local anaesthesia in an outpatient setting. Seventy-seven patients, who underwent this procedure, were interviewed three months later concerning pain during treatment, pain and bleeding in the immediate postoperative period, and their general opinion about this procedure. The median duration of surgery was 11 minutes. The postoperative median observation time was 90 minutes. Seventy-one women experienced no discomfort during treatment. Thirty-one patients needed mild analgesics for an average of three days. Bleeding continued for a mean of 7.7 days after treatment and 73% experienced the bleeding as less, 8% as more as compared to menstrual bleeding. Ninety-two percent of the women would prefer this procedure if they had to undergo conization once again. In conclusion, we found a high acceptability in women treated with CO2 laser excisional conization under local anaesthesia in an outpatient setting.
To investigate change in hospital utilization in a population and to discuss analytical strategies using large administrative databases, focusing on variations in rates of different types of hospital utilization by income quintile neighborhoods.
Hospital discharge abstracts from Manitoba Health, used to study the changes in utilization rates over eight fiscal years (1989-1996).
We test the hypotheses that health reform has changed utilization rates, that utilization rates differ significantly across income quintiles (defined by the relative affluence of neighborhood of residence), and that these variations have been maintained over time. Our approach uses generalized estimating equations to produce robust and consistent results for studying rates of recurrent and nonrecurrent events longitudinally.
Rates of individuals hospitalized, hospital discharges, days of hospitalization, and hospitalization for different types of medical conditions and surgical procedures are generated for the period April 1, 1989 through March 31, 1997 for residents of Winnipeg, Manitoba. Data are grouped according to the individual's age, gender, and neighborhood of residence on April 1 of each of the eight fiscal years for the rate calculations. Neighborhood of residence and the 1991 Canadian Census public use database are used to assign individuals to income quintiles.
The substitution of outpatient surgery for inhospital surgery accounted for much of the change in hospital utilization over the 1989-1996 period. Health care reform did not have a significant effect on the utilization gradient already observed across socioeconomic groups. Health reform markedly accelerated declines in in-hospital utilization.
Grouping the data with key characteristics intact facilitates the statistical analysis of utilization measures previously difficult to study. Such analyses of variations across time and space based on parametric models allows adjustment for continuous covariates and is more efficient than the traditional nonparametric approach using standardized rates.
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The purpose of this quasi-experimental study was to examine the effect of acupuncture on postoperative pain in day surgery patients undergoing arthroscopic shoulder surgery. Twenty-two participants scheduled to undergo arthroscopic shoulder surgery were included. The results showed that on postoperative day one pain decreased (-1.1) in patients receiving acupuncture compared to the control group in which pain increased (2.0), p=.014. Sleep quality was also significantly higher in the acupuncture group compared to the control group, p=.042. In conclusions, acupuncture seems to have a reducing effect on postoperative pain as well as increase sleep quality in day surgery patients undergoing arthroscopic shoulder surgery. In regards to application, nurses should be encouraged to use additional nonpharmacologic approaches like acupuncture in postoperative pain management, as this can be a part of the multimodal analgesic regimes to improve patients care.
Population-based incidence rates and trends of acute Achilles tendon ruptures are not known. It is also not known whether recent high-quality randomized controlled trials not favoring surgery have had an effect on treatment protocols.
To assess the incidence of acute Achilles tendon ruptures in Sweden and to examine the trends in surgical treatment.
Descriptive epidemiology study.
We conducted a nationwide registry-based study including all adult (=18 years of age) inpatient and outpatient hospital visits because of an acute Achilles tendon rupture in Sweden between 2001 and 2012.
We identified a total of 27,702 patients (21,979 men, 79%) with acute Achilles tendon ruptures between 2001 and 2012. In 2001, the sex-specific incidence of acute Achilles tendon ruptures was 47.0 (per 100,000 person-years) in men and 12.0 in women. In 2012, the corresponding values were 55.2 in men and 14.7 in women, with an increase of 17% in men and 22% in women. The proportion of surgically treated patients declined from 43% in 2001 to 28% in 2012 in men and from 34% in 2001 to 22% in 2012 in women.
The incidence of acute Achilles tendon ruptures in Sweden is increasing. The most probable reason for this increase is the rise in the number of older adults participating in high-demand sports. The proportion of surgically treated patients is decreasing most likely because of recent high-quality randomized controlled trials and their meta-analyses supporting similar results between surgical and nonsurgical approaches.
Postoperative admissions to hospital from a hospital-based day-surgery unit were analysed over a period of 19 months. A total of 2,411 patients were surveyed. The admission rate within 24 hours of the operation was 1.5% (35 patients). Surgery, anaesthesia, pain and social reasons accounted for 37, 29, 20 and 14% of the admissions respectively. One patient was re-operated on. 24 patients (1%) were hospitalized later than 24 hours but within 30 days after surgery (mean 7.5 days), and were called re-admissions. Surgery (75.6%), pain (12.6%) and anaesthetic reasons (8.4%) accounted for the re-admissions. 12 patients (50%) underwent surgery when re-admitted. The number of admissions (4.1%, p
An increasing number of elderly patients are undergoing ambulatory surgery. We examined whether ambulatory surgery carries a higher risk for the elderly than for younger patients.
A total of 17,638 consecutive ambulatory surgical patients were enrolled in a prospective cohort study during a three-year period. Preoperative, intraoperative, and postoperative information was collected. Twenty-seven percent of the enrolled patients were 65 yr or older. Incidence rates of intraoperative and postoperative adverse events among the elderly were compared with those among younger patients; we controlled for sex, ASA physical status, body mass index, type of surgery, and duration of procedure, using multiple logistic regression models.
Elderly patients had a higher incidence of any intraoperative event (adjusted odds ratio, 1.4; 99.7% confidence interval [CI], 1.0-2.0) and of intraoperative cardiovascular events (adjusted odds ratio, 2.0; 99.7% CI, 1.3-3.0). They also had a lower incidence of any postoperative event (adjusted odds ratio, 0.4; 99.7% CI, 0.3-0.6) and of postoperative pain (adjusted odds ratio, 0.2; 99.7% CI, 0.1-0.4), nausea and vomiting (adjusted odds ratio, 0.3; 99.7% CI, 0.1-0.6), and dizziness (adjusted odds ratio, 0.4; 99.7% CI, 0.2-1.0).
The risks reported do not constitute a contraindication for elderly patients to undergo ambulatory surgery but this population may require more careful intraoperative cardiovascular management.
Comment In: Can J Anaesth. 1999 Nov;46(11):109510566936
Comment In: Can J Anaesth. 1999 Apr;46(4):305-810232712
The purpose of this study was to assess the current selection criteria for outpatient surgery in children among Canadian pediatric anesthesiologists.
A survey specifying 20 different medical situations was sent to 120 members of the Canadian Pediatric Anesthesia Society. Members were asked to indicate if they agreed or refused to provide anesthesia for children with one or more clinical condition or symptoms. Consensus was defined as a >70% majority opinion.
Sixty-four pediatric anesthesiologists replied (53.3%). For 13 conditions there was no consensus among members. Seven scenarios resulted in a consensus of either providing or not providing anesthesia in an outpatient setting. The majority of members would agree to provide anesthesia for the following scenarios: (i) an asymptomatic child with recurrent otitis media, rectal temperature of 38 degrees C; (ii) the same child with chronic nasal discharge for bilateral myringotomy and tube placement; (iii) an asymptomatic child with sickle-cell disease (SCD) for cast change; (iv) an asymptomatic child with asthma and fever for bilateral myringotomy and tube placement (BMT); (v) a morbidly obese child with congested nose for BMT; and (vi) a child with well controlled insulin dependent diabetes mellitus for magnetic resonance imaging (MRI). Most members would refuse to provide outpatient anesthesia in an asymptomatic child with SCD for tonsillectomy.
Further studies are needed to establish evidence-based medicine to support guidelines that would allow one to select children safely for ambulatory surgery.
One hundred and forty-eight patients were anaesthetized in the Day Care Hospital in Ribe and Varde during the period 1st July 1992-30th september 1992. They answered a questionnaire concerning their treatment and their satisfaction. One hundred and twenty-eight patients answered the questionnaire. Sixty-six percent were nervous to some degree, especially the youngest and the women. Nevertheless, 57% men and only 28% of the women wanted sedatives prior to the operation. We concluded that premedication such as midazolam or triazolam should be available. The postoperative pain and side effects were significantly lower using regional analgesia as compared to general anaesthesia. Regional analgesia should be used when possible. There was no detected effect of using naproxen as premedication. The patients were very satisfied with the treatment. If necessary, 96% would prefer to be operated in a Day Care unit again.