Daytime hip arthroplasty refers to a medical procedure where a patient undergoes admission, surgery, and discharge all within a single day (24 hours). The establishment of daytime hip arthroplasty centers signifies a significant paradigm shift in the development model of modern hospitals. While numerous nationally accredited large medical institutions are undertaking daytime hip arthroplasty in various forms and scales, there remains a lack of standardized system processes and criteria. In this context, the National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Bone and Joint Specialty Committee of the China Ambulatory Surgery Alliance, Joint Surgery Branch of the Chinese Orthopedic Association, and Osteoarthritis Study Group of the Chinese Association of Orthopedic Surgeons have collaboratively organized experts in the relevant field domestically. Leveraging international experiences in daytime hip arthroplasty and integrating them with the clinical practices of well-established medical institutions conducting daytime surgeries in China, they have arrived at consensus recommendations. These recommendations cover the establishment of daytime hip arthroplasty centers, policies, procedures, and perioperative management. The ultimate goal is to provide reference points and guidance for the standardized implementation of daytime hip arthroplasty.
ObjectiveTo explore the management experience of day surgery in children specialized hospitals.MethodsWuhan Children’s Hospital began one-day pediatric surgery in 1981. In 2001, one-day surgery center was formally established to centralize treatment and management. In the past three years, the mixed management of centralized and decentralized treatment was increased. At the same time, the one-day surgery management process was optimized, the relevant access and evaluation system was strictly implemented, to ensure the medical quality and medical safety.ResultsSince 2001, more than 120 000 cases of day surgery had been performed in the hospital, without death or other serious complications. The incidence of common postoperative complications was less than 0.8%, and the time of occurrence of complications was mainly within 12 hours after surgery. By 2018, the number of day surgeries in the hospital accounted for 29.57% of the annual elective surgeries, and the overall incidence of complications was lower than the traditional hospitalization mode of the same disease.ConclusionsThe concept of patient-centered service is truly embodied in day surgery. Specialized hospitals, especially children’s hospitals, have a large number of single diseases, a large demand for patients’ surgeries, a high degree of homogeneity of surgeries, good surgical results, and urgent needs and advantages to carry out day surgery. Day surgery is suitable to start in developed departments, and be promoted in other specialties of the hospital when experience has been accumulated, so as to increase the proportion of day surgery in elective surgery gradually.
The traditional view is that breast reconstruction is not an option for day surgery center. As a result, few hospitals in the world conduct this operation in day surgery center. Endoscopic breast reconstruction with liposuction and robot-assisted breast reconstruction are minimally invasive surgeries for breast cancer patients, but they cannot be carried out in the day surgery center due to long operation time. The novel endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy through a single axillary incision for breast cancer patients has been successfully conducted in the day surgery center in our hospital due to short operation time and small trauma. Standardized management of the complete process from the patient selection to follow-up after discharge brings rapid recovery and few complications. At the same time, the development of endoscopic surgery makes the breast almost scarless and improves aesthetic results. Therefore, the mode of endoscopic-assisted reconstruction in the day surgery center of our hospital is expected to be popularized in the whole country.
In the context of the burgeoning development of day surgery, the shortened hospital stay has led to a relative reduction in the professional care that patients receive. As a result, more stringent requirements for nursing quality management have emerged. Scientific and objective sensitive indicators can provide quantitative standards for monitoring and evaluating nursing quality. This article comprehensively reviews the definition, classification, construction steps, and methods of nursing quality sensitive indicators. Additionally, it delves into the current status of the construction and application of such indicators for day surgery both at home and abroad. Those insights can offer a scientific foundation for the management of nursing quality in day surgery settings.
Objective To explore the perioperative safety of video-assisted thoracic surgery (VATS) in Day Care Unit and the risk factors for delayed discharge under centralized management model. MethodsThe patients with VATS managed by the Day Care Unit of the Drum Tower Hospital Affiliated to Nanjing University Medical School in 2021 were retrospectively collected. The patients’ postoperative data and risk factors for delayed discharge were analyzed. ResultsA total of 383 patients were enrolled, including 179 males and 204 females with an average age of 46.09±14.82 years. Eleven (2.87%) patients developed grade 3-4 postoperative complications during the hospitalization. Eighteen (4.70%) patients visited unscheduled outpatient clinic within 7 days, and 6 (1.57%) patients were re-hospitalized within 30 days after discharge. The remaining patients had no significant adverse events during the 30-day follow-up. The average length of hospital stay was 2.27±0.35 d. The length of hospital stay was over 48 h in 48 (12.53%) patients. The independent risk factor for delayed discharge was lobectomy or combined resection (OR=3.015, 95%CI 1.174-7.745, P=0.022). ConclusionVATS can be safely conducted under the centralized management in Day Care Unit. The risk factor for delayed discharge is the extent of surgical resection.
Objective To explore the effect of constructing the closed-loop management of the wound in the day surgery patients and to reduce the incidence of poor wound healing after day surgery. Methods The medical records of patients with closed-loop wound management mode in the Day Surgery Center of West China Hospital of Sichuan University from 2019 to 2020 were collected retrospectively. The general data of patients were collected, and the cases of delayed wound healing after operation were counted. Results A total of 17 801 patients were included, 9 802 in 2019 and 7 999 in 2020. Laparoscopic cholecystectomy and adult tension-free hernia repair were the most common methods of delayed wound healing in day surgery. In the closed-loop management mode, the incidence of delayed wound healing was 0.98% (174/17 801) and the incidence of dissatisfaction related to delayed wound healing was 0.034% (6/17 801). Conclusion The clinical application of the closed-loop management of the wound in the day surgery can promote the early healing of day surgery patients, guarantee the quality of day surgery, and improve patient satisfaction.
ObjectiveTo investigate the feasibility, safety, cost, and patient satisfaction of ambulatory laparo-scopic cholecystectomy(ALC). MethodsThe clinical data of patients who divided into ALC group(678 cases) and in-patient laparoscopic cholecystectomy(IPLC) group(1 534 cases) in our hospital from April 2011 to December 2012 were retrospectively analyzed. The operative time, conversion rate, complication rate, hospitalization time, cost of hospi-talization, rehospitalization rate, and patient satisfaction were analyzed and evaluated. ResultsThere were no significant differences of the operative time, postoperative complication rate, and rehospitalization rate between the 2 groups(P > 0.05). The conversion rate(0.44%), and hospitalization time[(1.2±0.5)d] of the ALC group were significantly lower or shorter than those of IPLC group[3.19%, (4.8±1.3) d], P < 0.05. The direct, indirect health care costs, and the total costs of the ALC group were (6 555.6±738.7), (230.0±48.0), and (8 856.0±636.0) yuan, respec-tively; and lower than those of the IPLC group[(7 863.71, 014.6), (973.0±136.5), and(8 856.0±636.0)yuan], P < 0.05. ConclusionALC is safe and feasible, and could shorten the hospitalization time, lower the medical cost, speed up the bed turnover, and increase the efficiency in the use of health resource.
With the rapid development of day surgery mode in China, day surgery management has shifted from extensive to refined, but there are still many problems in the information system of day surgery in Chinese hospitals. The Second Affiliated Hospital Zhejiang University School of Medicine has developed a day surgery information management system since 2018, established a pre-hospital and in-hospital day surgery ecological management, and integrated daily management concepts and management rules into the system through the whole-process information management. It realized the whole process, full data, closed-loop and path-based information management of day surgery. This paper introduces the day surgery information management system of the Second Affiliated Hospital Zhejiang University School of Medicine, and aims to share the experience of building the day surgery information management function module.