ObjectiveTo investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery.MethodsA retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from January 2017 to April 2021 was performed, including 35 males and 39 females aged 12-38 (21.32±4.13) years. Patients were divided into two groups according to different treatments. There were 34 patients in a control group (adopting traditional surgery), and 40 patients in an observation group (adopting ambulatory surgery). The clinical effects of the two groups were compared.ResultsNo massive bleeding, conversion to thoracotomy, postoperative pneumothorax or severe pneumonia occured in all patients. Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost, operation time, anesthesia time or postoperative waiting time (P>0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group (P<0.05). The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group (P<0.05). There was no statistical difference in white blood count, neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups (P>0.05).ConclusionBased on the optimized diagnosis and treatment model, thoracoscopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery, is feasible and worth popularizing in thoracic surgery.
ObjectiveTo evaluate and analyze the clinical effect of ambulatory surgery applied to laparoscopic cholecystectomy (LC).MethodsThe patients who underwent LC in the First Affiliated Hospital of Xinjiang Medical University from June 2017 to February 2019 were collected, then were assigned to ambulatory surgery applied to LC group (ALC group) and conventional LC group (CLC group) according to the admission process mode. The patients in the ALC group received LC in the ambulatory ward and the patients in the CLC group received LC in the conventional ward. The preoperative waiting time, postoperative gastrointestinal recovery time, postoperative 6 h pain score, total hospitalization time, total hospitalization cost, patient satisfaction, and postoperative complications were compared between the two groups.ResultsA total of 433 patients underwent LC were included in this study, including 176 patients in the ALC group and 257 patients in the CLC group. There were no significant differences in the age, gender, type of gallbladder diseases, etc. between the two groups (P>0.05) except body mass index (P<0.05). There was no perioperative death in the two groups. One patient converted to laparotomy in the CLC group. Compared with the CLC group, the preoperative waiting time, postoperative gastrointestinal recovery time, and the total hospitalization time were shorter, the postoperative pain score was lower, the total hospitalization cost was less, and the satisfaction rate of patients was higher in the ALC group (P<0.05). There was 1 case of incision infection and 1 case of ascites in the operation area in the ALC group and CLC group, 1 case of fever in the ALC group and 3 cases of fever in the CLC group, respectively. There was no difference in the overall incidence of complications between the two groups (P>0.05). During the follow-up of 6 to 26 months, there was no readmission in both groups.ConclusionPatients who undergone LC based on ambulatory surgery mode recover quickly, and hospitalization cost is less, satisfaction rate is higher.
Enhanced recovery after surgery (ERAS) is a protocol designed to improve perioperative outcomes by multidisciplinary team with evidence-based interventions. The implementation of ERAS concept has been proved to reduce postoperative complications and hospital stay. The anesthesia management under the concept of ERAS is the basis of safe and smooth ambulatory surgical protocol. This article summarizes the latest clinical evidence at home and abroad, and reviews the preoperative optimization, anesthesia mode selection, ventilation strategies, fluid management, temperature support, pain management, postoperative nausea and vomiting prevention, postoperative nutritional support, and postoperative sleep improvement in the management of anesthesia under ERAS concept, in order to provide a reference for anesthesia management in ambulatory surgery.
Objective To evaluate the effect of optimizing the management measures of cataract ambulatory surgery. Methods The patients who underwent cataract phacoemulsification combined with intraocular lens implantation in the Ambulatory Surgery Center of East District of Beijing Tongren Hospital affiliated to Capital Medical University were selected. Patients between January and December 2021 (after the optimization of ambulatory surgery process) were included, and patients between January and December 2020 (before the optimization of ambulatory surgery process) were included as control. The three factors of age, gender and surgical eye type were used as predictive variables for propensity score matching. The proportion of patients who completed the surgery according to the scheduled time, the proportion of eye drops used according to the doctor’s instructions and the number of hospital visits before and after the optimization of the ambulatory surgery process were compared with the patients who successfully matched. Results A total of 28306 patients were included, including 13284 before and 15022 after process optimization. There were 13467 males and 14839 females, with a median age of 70 (60, 78) years. There was no statistically significant difference in the age of patients before the process optimization (P>0.05), but there was statistically significant difference in gender and surgical eye (P<0.05). After the propensity score matching, a total of 12932 pairs of patients were matched successfully. After the propensity score matching, there was no statistically significant difference between the two groups in age, gender and surgical eye (P>0.05). After the process optimization, the proportion of patients who completed surgery on schedule (98.8% vs. 93.3%) and used eyedrops according to the doctor’s instructions (97.4% vs. 93.0%) were higher than that before the process optimization, and the proportion of patients who came to hospital more than 3 times (0.7% vs. 1.9%) was lower than that before the process optimization (P<0.05). Conclusion The optimized ambulatory surgery process can help patients complete the surgery according to the scheduled time and use eye medication according to the doctor’s instructions, and can reduce the number of patients coming to the hospital.
Objective To investigate the safety and feasibility of hysteroscopic treatment for retained products of conception (RPOC) combined with enhanced myometrial vascularity (EMV) in ambulatory surgery mode. Methods A retrospective analysis was conducted on the clinical data of patients who underwent hysteroscopic treatment for RPOC combined with EMV in ambulatory surgery mode at West China Second University Hospital between May 2021 and May 2024, including their basic information and surgical related conditions. Results A total of 54 patients were included, with an average age of (33.37±4.54) years and an average number of pregnancies of 3.14±1.56. The preoperative blood level of human chorionic gonadotropin was 11.45 (5.00, 82.96) mU/mL. Color Doppler ultrasound showed an average size of pregnancy residue (2.47±0.77) cm. The average peak systolic velocity was (55.13±18.55) cm/s. The intraoperative blood loss was 17.63 (1.00, 300.00) mL. The average surgical time was (30.07±20.64) minutes. The hospital stay was 0.69 (0.50, 1.00) days. There was 1 case of postoperative complications (incidence rate 1.9%), which had the second hysteroscopy to remove retained pregnancy tissue one month after the first surgery due to RPOC. There were 6 cases of postoperative re pregnancy. Conclusion Hysteroscopic treatment for RPOC combined with EMV in ambulatory surgery mode is safe and feasible, and is worth promoting.
Global ambulatory surgery services center on efficiency optimization, while China, against the backdrop of the medical and health system reform, has realized the transformation from “ambulatory surgery” to “ambulatory care”, shifting from an efficiency-oriented approach to a dual orientation of system restructuring + patient needs. Adopting a combined method of literature review and policy text analysis, this paper systematically sorts out more than 30 core policy documents issued at the national level over the past 20 years and nearly 100 papers from core domestic journals, and constructs an integrated analytical framework of “policy-concept-model”. The study clarifies the policy evolution logic of Chinese-style ambulatory care featuring “instrumental application → systematic integration → strategic restructuring”, and defines the hierarchical relationship and boundaries between “ambulatory surgery” and “ambulatory care”. This review provides a referential practical guide for different types of medical institutions and highlights the core value of Chinese-style ambulatory care as a key initiative for the supply-side structural reform of medical services.
Objective To compare the effects of WeChat applet follow-up and traditional follow-up on postoperative recovery quality of patients undergoing ambulatory knee arthroscopy surgery. Methods Participants who planned to undergo knee arthroscopic meniscus repair in the Ambulatory Surgery Center of the First Affiliated Hospital of Anhui Medical University between September 2024 and April 2025 were enrolled. Patients were divided into WeChat applet follow-up group (App group) and traditional telephone follow-up group (control group) by random number table method. The basic information of patients was collected, and the quality of recovery, pain score, medication use, nausea and vomiting, sleep quality, analgesic satisfaction and satisfaction with treatment were evaluated on the first and third day after surgery. Results A total of 80 patients was enrolled, with 40 patients in each group. There were no significant differences in baseline characteristics between the two groups (P>0.05). The total score of postoperative recovery quality in the control group was lower than that in the App group [postoperative day 1: (108.2±9.6) vs. (112.5±9.2) scores, postoperative day 3: (112.0±9.1) vs. (118.3±8.7) scores], physiological comfort [postoperative day 1: (21.8±2.9) vs. (23.4±2.7) scores, postoperative day 3: (23.1±2.6) vs. (25.6±2.4) scores]. There were no significant differences between the two groups in postoperative nausea and vomiting, length of stay in post-anesthetic care unit, total dosage of postoperative analgesics, time to first report of pain, time to first request for analgesia, sleep quality score on the night after surgery, and analgesic satisfaction score within 24 hours after surgery (P>0.05). The satisfaction score of the App group was higher than that of the control group at 1 week after surgery (P<0.001). Conclusion Compared with the traditional follow-up method, the follow-up based on the WeChat applet can effectively improve the early postoperative recovery quality and treatment satisfaction of patients undergoing ambulatory knee arthroscopy surgery, and has no significant effect on other clinical outcomes.
Objective To investigate the effect of penehyclidine hydrochloride on postoperative nausea and vomiting (PONV) in patients undergoing ambulatory laparoscopic cholecystectomy. Methods The medical records of patients who underwent laparoscopic cholecystectomy in ambulatory surgery mode at General Hospital of Northern Theater Command between October 2024 and October 2025 were retrospectively collected. According to whether penehyclidine hydrochloride was used during operation, the patients were divided into a study group (penehyclidine hydrochloride used during operation) and a control group (penehyclidine hydrochloride not used during operation). The general information, perioperative period indicators, the overall incidence of PONV within 48 hours after surgery, the severity and incidence of PONV at different postoperative periods, the incidence of adverse reactions and patient satisfaction of the two groups of patients were compared. Results A total of 110 patients were included, among whom 55 were in the study group and 55 were in the control group. Compared with the control group, the overall incidence of PONV within 48 hours after surgery in the study group decreased (34.5% vs. 56.4%; χ2=5.280, P=0.022), the severity and incidence of PONV at each time period from 0 to 6 hours, 6 to 12 hours, and 12 to 24 hours decreased (P<0.05), and the usage rate of rescue antiemetic drugs decreased (10.9% vs. 29.1%; χ2=5.682, P=0.017). The incidence of dry mouth (30.9% vs. 10.9%; χ2=6.652, P=0.010) and patient satisfaction [85 (75, 85) vs. 75 (70, 75); Z=5.531, P<0.001] in the study group were higher than those in the control group. There was no statistically significant difference in the general data of the patients, perioperative indicators except rescue antiemetic drugs, the severity and incidence of PONV from 24 to 48 hours after surgery, or dizziness, drowsiness, blurred vision, urinary retention, skin itching or other adverse reactions between the two groups (P>0.05). Conclusions The intraoperative use of penehyclidine hydrochloride in patients undergoing laparoscopic cholecystectomy in ambulatory mode can effectively reduce the incidence and severity of postoperative PONV. The overall safety is good and the patient satisfaction is high. It can be promoted and applied in the clinical anesthesia of ambulatory surgery.
Objective To investigate the effect of postoperative sleep disturbance by infusion of low dose esketamine during ambulatory laparoscopic cholecystectomy. Methods Patients undergoing ambulatory laparoscopic cholecystectomy under general anesthesia in General Hospital of Northern Theater Command between August and November 2024 were selected. They were randomly divided into esketamine group and control group based on a random number generator. Patients in the esketamine group received a continuous infusion of esketamine [0.3 mg/(kg·h)] during the operation. Patients in the control group received the equivalent volume of saline. The scores of the Athens Insomnia Scale on the first day before surgery, the first day after surgery, and the third day after surgery, the incidence of sleep disturbance and the Hospital Anxiety and Depression Scale score on the first day and the third day after surgery, mean artial pressure and heart rate during surgery, operation time, anesthesia time, recovery time, total dosage of remifetanil and vasoactive drug, postoperative adverse reactions, and the Visual Analogue Scale score on the day of surgery and the first day after surgery were compared between the two groups. Results A total of 105 patients were included, including 52 in the control group and 53 in the esketamine group. The differences were statistically significant in the incidence of sleep disorders on the first day after surgery (22.64% vs. 46.15%; χ2=6.440, P=0.011), the Athens Insomnia Scale score on the first day after surgery [4 (1.5, 5) vs. 5 (4, 7); Z=−2.933, P=0.003] , the cumulative amount of remifentanil used during surgery [884 (600, 1 112) vs. 572 (476, 872) μg; Z=−2.774, P=0.006], and the Visual Analogue Scale score on the day of surgery [2 (2, 3) vs. 3 (2, 3); Z=−2.488, P=0.013] between the esketamine group and the control group. There was no significant difference in mean arterial pressure, heart rate, operation time, anesthesia time, recovery time, vasoactive drug dosage, Hospital Anxiety and Depression Scale score or incidence of postoperative adverse reactions between the two groups (P＞0.05). Conclusion Continuous intraoperative infusion of low dose esketamine can improve postoperative sleep disturbance, without increasing the incidence of postoperative adverse reactions in patients undergoing ambulatory laparoscopic cholecystectomy.
ObjectiveTo identify the influencing factors for 24 hours delayed discharge after inguinal hernia surgery and to construct a predictive model for assessing postoperative 24 hours delayed discharge. MethodsThis study adopted a retrospective approach to collect the clinical data of 1 499 postoperative inguinal hernia patients who were admitted to the Department of General Surgery, Shaanxi Provincial People’s Hospital from Jan. 2021 to Dec. 2023. Multivariate logistic regression analyses was performed, and a nomogram was developed based on the multivariate results. Model discrimination was evaluated using receiver operating characteristic curve, calibration was assessed using calibration plots, and clinical utility was examined using decision curve analysis (DCA). ResultsThe results of the comprehensive multivariate regression analysis clearly indicated that open surgery [OR=4.085, P＜0.001], neuraxial anesthesia [OR=13.275, P＜0.001], general anesthesia [OR=6.414, P＜0.001], operation time>90 min [OR=1.575, P=0.008], intraoperative blood loss>5 mL [OR=1.530, P=0.003], medical adhesive-assisted closure [OR=0.683, P=0.038], postoperative pain score≥3 [OR=9.907, P＜0.001], postoperative nausea and vomiting [OR=2.553, P＜0.001], postoperative urinary retention [OR=4.534, P=0.001], postoperative scrotal edema [OR=2.105, P=0.001] were influencing factors for 24 hours delayed discharge after inguinal hernia surgery. A nomogram was constructed accordingly to the results and the area under the curve of the prediction model was 0.823 [95%CI (0.802, 0.844)]. The calibration curve demonstrated that the predictive model had good predictive performance (χ2=10.167, P=0.253). The DCA demonstrated that the predictive model yielded the maximum net benefit when the threshold probability ranged from 10% to 80%. ConclusionsFor patients undergoing inguinal hernia repair, open surgery, neuraxial and general anesthesia, operation time>90 min, intraoperative blood loss>5 mL, non-medical adhesive-assisted closure, postoperative pain score≥3, as well as the occurrence of postoperative nausea and vomiting, urinary retention and scrotal edema are the risk factors of delayed discharge beyond 24 hours. Based on these findings, targeted perioperative assessment, management and preventive interventions can be implemented in clinical practice, which not only facilitates early postoperative discharge for inguinal hernia patients, but also indirectly provides a reference for the admission criteria of ambulatory surgery patients.