Patient selection in ambulatory anesthesia — An evidence-based review: part I

Bryson, Gregory L.; Chung, Frances; Finegan, Barry A.; Friedman, Zeev; Miller, Donald R.; Vlymen, Janet van; Cox, Robin G.; Crowe, Marie -Josée; Fuller, John; Henderson, Cynthia L.

doi:10.1007/bf03018449

Cited by 62 publications

(24 citation statements)

References 82 publications

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“…Las complicaciones menores tienen un riesgo mínimo para producir lesiones importantes. Los estudios afirman que las complicaciones mayores no son frecuentes y la mortalidad es extremadamente baja (9,10) Los casos de infarto de miocardio, embolismos pulmonares y alteraciones cerebrales son extremadamente bajos, con una incidencia tan baja como la que puede ser esperada por la edad del paciente en grupos sin intervención quirúrgica (6,11,12). Los eventos suelen aparecer aproximadamente en los dos primeros días tras la intervención, aunque se estima que aproximadamente un 40% ocurrirán entre las 48 horas y el mes tras el acto médico (11,13).…”

Section: Discussionunclassified

“…Esta modalidad quirúrgica es aplicable a pacientes ASA III y IV que tengan controladas sus enfermedades y estén en situación estable. Las complicaciones perioperatorias están más frecuentemente relacionadas con la cirugía que con la condición médica (12,(14)(15)(16)(17), al contrario de lo que ocurre con la cirugía oftalmoló-gica. Las complicaciones de la cirugía de catarata en la mayoría de las series son rotura capsular, hipertensión ocular, endoftalmitis, descompensación endotelial corneal, desprendimiento retiniano, dehiscencias de sutura, uveítis anterior, opacificación capsular posterior, edema macular y hemorragias oculares (18).…”

Section: Discussionunclassified

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Resultados de un programa de cirugía mayor ambulatoria en oftalmología

Cortiñas

Martínez

Granados

et al. 2006

Arch Soc Esp Oftalmol

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RESUMENObjetivo: Evaluar los resultados de un programa de cirugía mayor ambulatoria en pacientes intervenidos quirúrgicamente de diversas patologías oculares en nuestro hospital. Métodos: Este estudio retrospectivo incluye 13.878 pacientes intervenidos de forma programada por el Servicio de Oftalmología desde septiembre de 1998 a diciembre de 2004. En 11.187 pacientes se realizaron diferentes procedimientos quirúrgicos de forma ambulatoria, siendo la cirugía de catarata (facoemulsificación) la operación mayoritaria (8.155 casos). Se han analizado diversos índices (sustitución, suspensión, ingresos, reingresos), así como el rendimiento quirúrgico y las complicaciones sisté-micas y oculares que surgieron dentro de las primeras 72 horas tras la cirugía. La medición de las variables se realizó mediante frecuencias relativas. El análisis utilizado para la evolución de las complicaciones en el período de estudio fue la Chi cuadrado de tendencias. Resultados: 13.878 pacientes fueron intervenidos en el período indicado, de los que 11.187 se operaron de forma ambulatoria (índice de sustitución global del 80,6%). El rendimiento quirúrgico medio fue 74,36%. El índice de ingresos tras la cirugía fue ARTÍCULO ORIGINAL ABSTRACT Purpose: To evaluate the outcomes in our hospital of an ambulatory major surgery program in patients with a variety of different ocular pathologies. Method: This retrospective study includes 13,878 patients who underwent programmed surgery by the Department of Ophthalmology between September 1998 and December 2004. Different ophthalmological surgical procedures were performed as outpatient surgery in 11,187 patients, with cataract surgery (phacoemulsification) being the most frequent operation performed (8,155 cases). We have analysed several indicators (substitution, suspension, admission and readmission rates), as well as surgical yield and systemic and ocular complications which appeared within 72 hours after surgery. The variables were measured as relative frequencies. The evolution of complications during the study period was analysed by the Chi-square trend test. Results: 13,878 patients had ophthalmic surgery during the study period; 11,187 had outpatient surgery with a global substitution ratio of 80.6%. The median surgical yield was 74.36%. The admission rate after surgery was 4.46% (499 patients), with 92.18% (460) of these requiring immediate admission. Twenty-one patients suffered from severe

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Section: Discussionunclassified

Resultados de un programa de cirugía mayor ambulatoria en oftalmología

Cortiñas

Martínez

Granados

et al. 2006

Arch Soc Esp Oftalmol

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“…In particular, patient visits to freestanding ambulatory surgery centers (ASCs), facilities physically separate from acute-care hospitals, increased by 300 percent between 1996 and 2006 (Cullen, Hall, & Golosinskiy, 2009) (Lynk and Longley, 2002). Prior approaches to patient selection in procedural care have focused exclusively on balancing the anticipated benefits of a given procedure with the probability of a complication as determined by patient and procedural factors (Bryson et al, 2004). As ASCs and HOPDs differ in their access to hospital care, physicians must also decide on the appropriate care setting based on the probability of a surgical complication and the accessibility to hospital services that may be critical to the management of such a complication.…”

Section: Introductionmentioning

confidence: 99%

Physician division of labor and patient selection for outpatient procedures

David

Neuman

2011

Journal of Health Economics

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Little is known about the ability of incentives to influence decisions by physicians regarding choices of settings for care delivery. In the context of outpatient procedural care, the emergence of freestanding ambulatory surgery centers (ASCs) as alternatives to hospital-based outpatient departments (HOPDs) creates a unique opportunity to study this question. We advance a model where physicians' division of labor between ASCs and HOPDs affects the medical complexity of patients treated in low-acuity settings (i.e. ASCs). Analyses of outpatient surgical procedure data show that physicians working exclusively in low-acuity settings (i.e. ASCs) treat patients of significantly higher medical complexity in these settings than do physicians who also practice in higher-acuity settings (i.e. HOPDs). This discrepancy shrinks with increasing procedural risk and with increasing distance between ASCs and acute care hospitals. AbstractLittle is known about the effect of incentives on physicians' choices of settings for medical procedures. We advance a model where physicians' division of labor between ambulatory surgery centers (ASCs) and hospital-based outpatient departments (HOPDs) affects the medical complexity of patients treated in low-acuity settings (i.e. ASCs). Analyses of outpatient surgical procedure data show that physicians working exclusively in low-acuity settings (i.e. ASCs) treat patients of significantly higher medical complexity in these settings than do physicians who also practice in higher-acuity settings (i.e. HOPDs).This discrepancy shrinks with increasing procedural risk and with increasing distance between ASCs and acute care hospitals.

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“…9,17,[22][23][24][25][26] Overall, the most encountered adverse events were cardiovascular -in cardiac patients; or postoperative respiratory -in asthmatic, morbidly obese, and sleep apnea patients. 10 Recognition and optimization of comorbid medical conditions in advance of the day of surgery is crucial because it enables implementation of perioperative preventative measures that minimize adverse events.…”

Section: Management Of Comorbidities In Ambulatory Anesthesiamentioning

confidence: 99%

Management of comorbidities in ambulatory anesthesia: a review

Dabu-Bondoc¹,

Shelley²

2015

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Advances in medical science now allow people with significant medical issues to live at home. As the outpatient population ages and surgical techniques advance, the ambulatory anesthesiologist has to be prepared to handle these "walking wounded". The days of restricting ambulatory surgery procedures to American Society of Anesthesiologists class 1 and 2 patients are rapidly fading into the past. To remain competitive and economically viable, the modern ambulatory surgery center needs to expand its practice to include patients with medical comorbidities. In an environment where production and economic pressures exist, maintaining safety and good outcomes in high-risk patients for ambulatory surgery can be arduous. Adding to the complexity of this challenge is the rapid evolution of the therapeutic approaches to a variety of medical issues. For example, there has been a significant increase in the number and types of insulin a diabetic patient might be prescribed in recent years. In the case of the patient with coronary artery disease, the variety of both drug and nondrug eluding stents or new antithrombotic agents has also increased the complexity of perioperative management. Complex patients need careful, timely, and team-based preoperative evaluation by an anesthesia provider who is knowledgeable of outpatient care. Optimizing comorbidities preoperatively is a crucial initial step in minimizing risk. This paper will examine a number of common medical issues and explore their impact on managing outpatient surgical procedures.

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Patient selection in ambulatory anesthesia — An evidence-based review: part I

Cited by 62 publications

References 82 publications

Resultados de un programa de cirugía mayor ambulatoria en oftalmología

Resultados de un programa de cirugía mayor ambulatoria en oftalmología

Physician division of labor and patient selection for outpatient procedures

Management of comorbidities in ambulatory anesthesia: a review

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