Day Surgery Program at West China Hospital: Exploring the Initial Experience

Association Between Pre-Hospital e-Education via QR Code and Hospital Stay in Inguinal Hernia Patients Undergoing General Anaesthesia: A Retrospective Study

Purpose

Exploring the retrospective analysis of the association between pre-hospital e-education via QR code and the hospital stay for inguinal hernia patients undergoing general anesthesia.

Patients and Methods

A retrospective study was conducted to explore the association between pre-hospital e-education utilizing QR code and hospital stay in patients with inguinal hernia repair under general anesthesia between August 2022 to June 2024. Patients were categorized into two groups based on their engagement with the pre-hospital e-education: those who accessed the pre-hospital e-education (viewing group) and those who did not (non-viewing group). The t-tests or Mann-Whitney U-tests were utilized to compare the means of the two groups, while the chi-square test was used to assess the rates between the two groups. To further explore the relationship between pre-hospital e-education and hospital stay, as well as other related factors, correlation analysis and multiple linear regression analysis were carried out.

Results

There were significant differences in the patient's hospital stay, the time to first postoperative ambulation and dietary, anxiety, pain, and patient satisfaction. The analyses revealed statistically significant correlations between viewing pre-hospital e-education via QR code and hospital stay, the time to first postoperative ambulation and dietary, anxiety, pain, as well as patients' satisfaction (P<0.05). This fully adjusted linear regression analysis revealed a significant negative correlation between viewing the pre-hospital e-education and hospital stay (β = -4.06, 95% CI: -6.43, -1.70; P =0.002). Similarly, a negative correlation was observed between viewing the pre-hospital e-education and the time to first ambulation (β = -0.71, 95% CI: -1.25, -0.17; P =0.015), as well as the time to first postoperative dietary (β = -1.20, 95% CI: -1.71, -0.34; P =0.006) after controlling for relevant covariates.

Conclusion

Effective pre-hospital e-education via online QR codes may reduce hospital stay and improve the patient experience in day surgery under general anesthesia.

Feasibility of twenty-four-hour discharge of patients with anterior mediastinal tumors after subxiphoid video-assisted thoracoscopic surgery (VATS) procedure

Background

A wide variety of surgical procedures are administrated in day-surgery unit and are able to be discharged within 24 hours with high efficiency, safety and economy. This study sought to evaluate the safety and feasibility of 24-hour discharge of patients with anterior mediastinal tumors after subxiphoid video-assisted thoracoscopic surgery (VATS) and describe our surgery procedure experiences.

Methods

A total of 70 selected patients with anterior mediastinal tumors undergoing subxiphoid VATS were included in this prospective study. The patients' clinical features, intraoperative and postoperative complications were assessed, and postoperative pain scale and satisfaction scores were also evaluated.

Results

The subxiphoid VATS was completed with no conversion to open surgery in all included patients and were all discharged within 24 hours after surgery. The mean operative time ± standard deviation (SD) was 70.50±18.98 min, and the mean operative blood loss volume ± SD was 45.50±15.25 mL. In addition, 80% of the patients reported a postoperative pain scale score less than 3 by the day before discharge, and all patients expressed satisfaction with receiving VATS in the day-surgery unit at 2 weeks after discharge.

Conclusions

The use of subxiphoid VATS is a safe, efficient and feasible surgical approach for patients with anterior mediastinal tumors discharged within 24 hours.

[Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition)]

To alleviate the medical burden of lung cancer surgery and facilitate the implementation of the national hierarchical diagnosis and treatment policy, it is imperative to establish a hierarchical diagnosis and treatment system for day surgery of lung cancer. Identifying key quality control checkpoints in day surgery of lung cancer is essential to enhance medical quality, ensure safety, and improve the efficiency of medical services. These efforts aim to uphold a safe and well-structured progression of day surgery practices in China. The Chinese Expert Consensus Group on Day Surgery Management of Lung Cancer has convened national experts in relevant fields and integrated the latest research findings from both domestic and international sources to craft the Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition). This consensus is founded on the principles of holistic management of lung cancer surgery and comprehensive patient care throughout their medical journey. It encompasses preoperative assessments, anesthesia protocols, surgical procedures, postoperative care, hospital-community collaboration initiatives, and emergency response strategies. The primary objective of this expert consensus is to furnish research assistance and clinical recommendations to advance the practice of day surgery for lung cancer patients in China.
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The development of day surgery in China and the effectiveness and reflection of day surgery in ophthalmology-specialized hospitals

This survey investigates the development of day surgery in China, and analyzes the national policy support, medical service management model, disease types of day surgery, medical insurance payment methods, and the medical service capacity, efficiency, quality and safety, health economics indicators, and patient satisfaction after the implementation of day surgery in a tertiary eye hospital. After more than 20 years of development, China's day surgery has shown a good development trend. The implementation of day surgery in eye hospitals accounts for more than 70% of elective surgery, and patients, medical institutions, and medical insurance institutions have all achieved good social benefits.

Evaluation of a concise fall risk stratification among older adults with cataracts in day surgery settings: A historically controlled study

AIM

This study aimed to evaluate the use of a concise fall risk stratification in assessing and predicting falls compared with the Morse Falls Scale among older adults with cataracts in day surgery settings.

METHODS

A historically controlled study conducted from July 2020 to June 2022 was used in a municipal ophthalmic hospital in China. The concise fall risk stratification which directly graded fall risk by multifactorial judgment was used during the intervention period, while the Morse Falls Scale which graded fall risk by scale scores was used during the control period. The fall risk levels, fall assessment time, fall rates, fall-related injuries, predictive validity, and patient satisfaction with day surgery care were extracted. Propensity score matching was performed to balance baselines.

RESULTS

After matching, 4132 patients were included in the final analysis. Compared with the control group, the intervention group had significantly higher assessment results for fall risk level, a significantly shorter (by 48.15%) fall assessment time, and higher patient satisfaction. There were no differences in fall rates and fall-related injuries. Compared with the Morse Falls Scale, the concise fall risk stratification had higher sensitivity and negative predictive validity, and lower specificity and positive predictive validity, while the area under curve did not differ significantly.

CONCLUSION

The use of the concise fall risk stratification reduced fall assessment time, improved patient satisfaction, and is unlikely to impact falls with an overall predictive performance comparable to that of the Morse Falls Scale for older cataract adults in day surgery settings.

Feasibility and applicability of pulmonary nodule day surgery in thoracic surgery

Background

More patients with lung diseases were identified with low-dose computed tomography (CT) popularization and increasing physical examination awareness. Day surgery was routinely conducted in many departments as a relatively mature diagnosis and treatment mode. Thus, this study aimed to assess the feasibility of day surgery in thoracic surgery for pulmonary surgery and provide guidance for selecting suitable patients.

Methods

This study retrospectively analyzed the clinical data of patients with pulmonary nodule surgeries. Patients were divided into the day and routine surgery groups following chest tube removal within 48 h postoperatively and the discharge criteria. Each group was further divided into the wedge and anatomic lung resection groups. The feasibility and applicability of day surgery in thoracic surgery was evaluated by calculating the percentage of the day surgery group and comparing the clinical data of the two groups, and corresponding guidance was given for selecting suitable patients for day surgery.

Results

The day surgery group accounted for 53.4% of the total number of patients in both groups. Data comparison revealed differences in age, hypertension, coronary heart disease, pulmonary function index, nodule localization, pleural adhesion, total postoperative drainage, and complications in the wedge resection and age, gender, smoking history, pulmonary function indexes, intraoperative adhesions, operative duration, total postoperative drainage volume, and complications in the anatomic lung resection (P < 0.05). There were no significant differences in the rates of re-hospitalization (1/172 ratio 1/150) and re-drainage (0/172 ratio 1/150) (P > 0.05).

Conclusion

This study concluded that more than half of the pulmonary surgery can be applied to the treatment mode of day surgery, and day surgery can be applied to the screened patients. It conforms to the concept of accelerated rehabilitation and can speed up bed turnover so that more patients can receive high-level medical treatment promptly.

Anxiety Severity and Influencing Factors in Day Surgery Patients or Relatives in Covid-19 Normalized Prevention Phase

BACKGROUND

As the 2019 Coronavirus Disease (COVID-19) repeated, the prevention and treatment will be normalized in a period. "Large number of patients" and " Turnover quickly" of the day surgery ward greatly increased the difficulty of policy formulation and implementation. The normalization also had a huge negative psychological impact on patients/family members. This study aims to introduce effective epidemic prevention and control measures in day surgery wards, and to clarify the influencing factors of anxiety and subjective discomfort of patients and their families during the normalization of COVID-19.

METHODS

To prepare for normalization of epidemic, research discuss improvements in the management of staff, environment, process. A total of 148 patients admitted to West China Hospital from December 2021 to March 2022 and their relatives were asked to complete a questionnaire effectively. Using the Self-rating Anxiety Scale, Social Support Rating Scale and Subjective Units of Distress scales to analyze anxiety and its risk factors.

RESULTS

Under normalized control measures, no staff was infected. The subjective discomfort score was higher in people with lower body mass index (BMI). Young and high social support score were risk factors for anxiety (P < .05), and social support was positively correlated with anxiety.

CONCLUSION

The normalization of epidemic is an inevitable trend in a period. A stable and safe medical environment needs to fully eliminate the policy defects, to fit the people and focus on mental health of the people. For patients/family members, who are younger,a lower BMI and higher social support should be attention more.

Safety and Feasibility of Video-Assisted Thoracoscopic Day Surgery and Inpatient Surgery in Patients With Non-small Cell Lung Cancer: A Single-Center Retrospective Cohort Study

Background and Objective: This study was undertaken to evaluate how safe and viable the use of video-assisted thoracoscopic day surgery (VATDS) is for individuals diagnosed with early-stage non-small cell lung cancer (NSCLC).

Methods: Data obtained from the selected patients with NSCLC who underwent video-assisted thoracoscopic surgery (VATS) in the same medical group were analyzed and a single-center, propensity-matched cohort study was performed. In total, 353 individuals were included after propensity score matching (PSM) with 136 individuals in the day surgery group (DSG) and 217 individuals in the inpatient surgery group (ISG).

Results: The 24-h discharge rate in the DSG was 93.38% (127/136). With respect to the postoperative complications (PPCs), no difference between the two groups was found (DSG vs. ISG: 11.76 vs. 11.52%, p = 0.933). In the DSG, a shorter length of stay (LOS) after surgery (1.47 ± 1.09 vs. 2.72 ± 1.28 days, p < 0.001) and reduced drainage time (8.45 ± 3.35 vs. 24.11 ± 5.23 h, p < 0.001) were found, while the drainage volume per hour (mL/h) was not notably divergent between the relevant groups (p = 0.312). No difference was observed in the cost of equipment and materials between the two groups (p = 0.333). However, the average hospital cost and drug cost of the DSG were significantly lower than those of the ISG (p < 0.001).

Conclusion: The study indicated that the implementation of VATDS showed no difference in PPCs, but resulted in shorter in-hospital stays, shorter drainage times, and lower hospital costs than inpatient surgery. These results indicate the safety and feasibility of VATDS for a group of highly selected patients with early-stage NSCLC.

Pivotal role of video-assisted thoracoscopic surgery in improving survival outcome of stage I non-small cell lung cancer in day surgery patients

BACKGROUND

Lung cancer, the leading cause of cancer-related deaths worldwide, has high morbidity rates. Video-assisted thoracoscopic surgery (VATS) as day surgery makes surgical treatment ideally in time with the same quality of medical care. This study aimed to assess the safety of stage I NSCLC patients who underwent VATS at a day surgery center.

METHODS

We retrospectively analyzed the clinical characteristics and tumor features of VATS patients at a single center, West China Hospital, from June 1, 2019, to December 31, 2020. Patients fulfilled all inclusion criteria, did not meet any exclusion criteria and underwent wedge resection, segmentectomy, or lobectomy with systematic lymph node dissection.

RESULTS

The median patient age was 43 (range, 19-67) years. Of the 209 patients, most were women. A total of 108 (51.7%) patients underwent segmentectomy, 87 (41.6%) lobectomy, and 14 (6.7%) wedge resection with systematic lymph node dissection. According to the AJCC/UICC eighth edition of lung cancer stage grouping, stages IA, IA1, IA2, and IA3 were 195 (93.3%), 122 (58.4%), 50 (23.9%), and one (0.5%), respectively. A total of 36 (17.2%) patients were stage 0. Adenocarcinoma was predominantly the postoperative pathological diagnosis, as only 14 (6.7%) were benign. A total of 201 (96.17%) patients were discharged without a chest tube. The most common chief complaints were cough, incisional pain, and shortness of breath. No severe complications or life-threatening emergencies were observed.

CONCLUSIONS

The day surgery mode of VATS for stage I NSCLC is safe and feasible, which makes surgical treatment ideally in time for stage I NSCLC patients with the same quality of medical care.

Video-Assisted Thoracoscopic Day Surgery for Patients with Pulmonary Nodules: A Single-Center Clinical Experience of 200 Cases

Background

We reviewed our experience with 200 patients who underwent video-assisted thoracoscopic day surgery (VATDS) at the Day Surgery Center at West China Hospital to identify the safety and feasibility of VATDS and assess the value of novel management in patients with pulmonary nodules.

Methods

Between June 2019 and December 2020, 200 patients with pulmonary nodules underwent VATDS at the Day Surgery Center at West China Hospital. The medical records of these 200 patients were reviewed for age, sex, preoperative history, operative and pathological findings, amount of daily chest tube drainage, procedure method and duration, length of stay (LOS), visual analog scale (VAS), and postoperative pulmonary complications (PPCs).

Results

There were 45 male and 155 female patients with a median age of 43 years (range 18 to 58 years). A total of 158 (79.00%) patients were diagnosed with lung adenocarcinoma, 35 (17.50%) were diagnosed with chronic inflammation with fibrous hyperplasia, and seven (3.50%) were diagnosed with granulomatous inflammation with necrosis. The mean LOS of the 200 patients was 1.25±0.95 days, and 187 (93.50%) patients were discharged within 24 hours as planned. Thirteen patients were transferred to the thoracic surgery ward for further treatment because of PPCs. The median VAS was 3 points (range 1 to 7 points), and the rate of PPCs was 11.50%.

Conclusion

Two hundred patients underwent VATDS with an acceptable 24-hour discharge rate. However, selection of patients for VATDS is required, and the implementation of VATDS on a larger scale requires further discussion.

Exploration of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture as day surgery: a retrospective study

BACKGROUND

The purpose of this retrospective study was to evaluate and compare the clinical outcomes of patients underwent PVP for OVCF as day surgery with the outcomes of patients managed as traditional inpatients.

METHODS

According to the selection criteria, patients who underwent PVP for single-segment thoracolumbar OVCF were included retrospectively in the day surgery procedure (DSP) group and the traditional inpatient procedure (TIP) group between April 2018 and September 2019. The visual analog scale score (VAS) and Oswestry Disability Index (ODI) score were recorded preoperatively and 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Duration of hospital stay, preoperative waiting time, hospital cost, and postoperative complications were recorded and analyzed.

RESULTS

A total of 335 patients (53 in DSP group; 282 in TIP group) were enrolled and completed 12-month follow-up. The mean duration of hospital stay, the mean preoperative waiting time, and the mean hospital costs were significant lower in the DSP group. The postoperative VAS and ODI scores in both groups were significantly improved after surgery. Moreover, both VAS and ODI scores at each follow-up stage were also significantly lower than the previous follow-up stage. However, the ODI score in the DSP group was significantly lower at 1-day, 1-week, 1-month, and 3-month follow-up, respectively. For cement leakage and secondary vertebral compression fractures, there was no statistical difference between the two groups.

CONCLUSIONS

We suggest that PVP for OVCFs in day surgery procedure is worthy of wide application.