Öz
Aim: Advances in medical and monitoring technologies have led to a rapid increase in daily surgical practices. In this study, it is aimed to present our outpatient anesthesia results.
Materials and Methods: In the prospective observational study, 907 patients who had outpatient surgery were included. Emergency patients, non-operating room anesthesia applications and operations not accompanied by the anesthesia team were excluded from the study. General anesthesia, regional anesthesia or sedo-analgesia were applied to the patients according to the procedure performed. Statistical significance was investigated between risk factors associated with complications and demographics data, anesthetic method, intraoperative and postoperative variables.
Results: In February 2020, 2194 patients were operated in our hospital and 907 (41.3%) of the patients met the outpatient criteria. 26.8% of the patients (243 patients) were pediatrics. Ophthalmological procedures were the most frequent ones (67%). The most common types of anesthesia was intratracheal general anesthesia (36.7%).
Intraoperative and postoperative complications developed respectively in 2.9% and in 1.9% of the patients. It was found that the complications were associated with endoscopic operations (OR: 4.357 [1.909-9.943], p˂0.001) and high basal heart rate (OR:1.030 [1.009-1.052], p=0.006).
Conclusion: While the endoscopic application of the operation and high basal heart rate were associated with complication, no complication-associated anesthesia method was found. The use of fast and short-acting anesthetics, analgesics and neuromuscular blockers, as well as improved monitoring methods, will reduce anesthesia complications during recovery.
Anahtar Kelimeler
Outpatient surgery outpatient monitoring Anesthesia Postoperative complications
Kaynakça
- Okocha O, Gerlach RM, Sweitzer B. Preoperative Evaluation for Ambulatory Anesthesia: What, When, and How? Anesthesiol Clin. 2019; 37 (2): 195-213.
- Seligson E, Beutler SS, Urman RD. Office-based anesthesia: an update on safety and outcomes (2017-2019). Curr Opin Anaesthesiol. 2019; 32 (6): 756-61.
- Preoperatif Hazırlık, TARD Anestezi Uygulamaları Kılavuzları, Türk Anesteziyoloji ve Reanimasyon Derneği (TARD), 2015. Erişim tarihi: 01.07.2020, Erişim adresi: https://www.tard.org.tr/assets/kilavuz/preoperatifdegerlendirme.pdf
- White PF, Freire AR. Ambulatory (Outpatient) Anesthesia in: Miller RD (ed) Miller’s Anesthesia Elsevier Churchill Livingstone, USA 6th ed, 2005; 2589-637.
- Hollingsworth JM, Birkmeyer JD, Ye Z, Miller DC. Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms. Surg Innov. 2014; 21 (6): 560-5.
- Gül R, Göksu S, Mızrak A, Koruk S, Öner Ü. Günübirlik cerrahi ünitemizde ilk sekiz aylık uygulamalarımız. Gaziantep Tıp. Dergisi 2008; 14 (2): 23-7.
- Friedman Z, Chung F, Wong DT, Canadian Anesthesiologists' Society. Ambulatory Surgery Adult Patient Selection Criteria - A Survey of Canadian Anesthesiologists. Can J Anaesth. 2004; 51 (5): 437-43.
- Ansell GL, Montgomery JE. Outcome of ASA III Patients Undergoing Day Case Surgery. Br J Anaesth. 2004; 92 (1): 71-4.
- Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999; 89 (6): 1352-9.
- Williams BA, Beaman ST, Kentor ML. Regional anesthesia group practice in the university hospital setting and ambulatory/regional anesthesia Clinical pathway formulation. Int Anesthesiol Clin. 2005; 43 (3):3-13.
- Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005; 101 (6): 1634-42.
- Klein SM, Pietrobon R, Nielsen KC, Warner DS, Greengrass RA, Steele SM. Peripheral nerve blockade with long-acting local anesthetics: a survey of the Society for Ambulatory Anesthesia. Anesth Analg. 2002; 94 (1): 71-6.
- Mezei G, Chung F. Return hospital visits and hospital readmissions after ambulatory surgery. Ann Surg.1999; 230 (5): 721-7.
- Twersky R, Fishman D, Homel P. What happens after discharge? Return hospital visits after ambulatory surgery. Anesth Analg.1997; 84 (2): 319-24.
- Warner MA, Shields SE, Chute CG. Major morbidity and mortality within 1 month of ambulatory surgery and ansthesia. JAMA 1993; 270 (12): 1437-41.
- Coley KC, Williams BA, DaPos SV, Chen C, Smith RB. Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. J Clin Anesth. 2002; 14 (5): 349-53.
- Junger A, Klasen J, Benson M, et al. Factors determining length of stay of surgical day-case patients. Eur J Anaesthesiol. 2001; 18 (5): 314-21.
- Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997; 85 (4): 808-16.
Öz
Amaç: Tıbbi teknolojideki ve monitörizasyondaki gelişmeler günübirlik cerrahi uygulamalarında hızlı bir artışa neden oldu. Bu çalışmada günübirlik anestezi sonuçlarımızın sunulması hedeflendi.
Gereç ve Yöntem: Günübirlik cerrahi geçiren 907 hasta prospektif gözlemsel olarak çalışmaya alındı. Acil hastalar, ameliyathane dışı anestezi uygulamaları ve anestezi ekibinin eşlik etmediği operasyonlar çalışma dışı bırakıldı. Hastalara yapılacak işleme göre genel anestezi, rejyonal anestezi veya sedo-analjezi uygulandı. Komplikasyonlarla ilişkili risk faktörleri ile demografik veriler, anestezi yöntemi, intraoperatif ve postoperatif değişkenler arasında istatiksel anlamlılık araştırıldı.
Bulgular: Hastanemizde Şubat 2020’de 2194 hasta operasyona alındı. Hastalardan 907’si (%41,3) günübirlik kriterlerini karşılamaktaydı. Hastaların %26,8’ini (243 hasta) pediyatrik hastalar oluşturmaktaydı. Göz hastalıkları (%67) en sık günübirlik operasyon yapılan klinik oldu. İntratrakeal genel anestezi (%36,7), en sık uygulanan anestezi şekliydi. İntraoperatif ve postoperatif komplikasyon sırasıyla hastaların %2,9’da ve %1,9’da gelişti. Operasyonun endoskopik yapılması (OR: 4,357 [1,909-9,943], p˂0,001) ve bazal kalp hızı yükseklikleri (OR:1,030 [1,009-1,052], p=0,006) peroperatif komplikasyonlar ile ilişkiliydi.
Sonuç: Operasyonun endoskopik uygulanması ve bazal kalp hızı yüksekliği peroperatif komplikasyon ile ilişkili iken; anestezi türü ile komplikasyon arasında anlamlı ilişki olmadığı saptandı. Hızlı ve kısa etkili anesteziklerin, analjeziklerin ve nöromuskuler blokörlerin yanı sıra geliştirilmiş monitörizasyon yöntemlerinin kullanımı perioperatif anestezi komplikasyonlarını azaltacaktır.
Anahtar Kelimeler
Günübirlik cerrahi Ayaktan hasta takibi Anestezi Postoperatif komplikasyonlar
Kaynakça
- Okocha O, Gerlach RM, Sweitzer B. Preoperative Evaluation for Ambulatory Anesthesia: What, When, and How? Anesthesiol Clin. 2019; 37 (2): 195-213.
- Seligson E, Beutler SS, Urman RD. Office-based anesthesia: an update on safety and outcomes (2017-2019). Curr Opin Anaesthesiol. 2019; 32 (6): 756-61.
- Preoperatif Hazırlık, TARD Anestezi Uygulamaları Kılavuzları, Türk Anesteziyoloji ve Reanimasyon Derneği (TARD), 2015. Erişim tarihi: 01.07.2020, Erişim adresi: https://www.tard.org.tr/assets/kilavuz/preoperatifdegerlendirme.pdf
- White PF, Freire AR. Ambulatory (Outpatient) Anesthesia in: Miller RD (ed) Miller’s Anesthesia Elsevier Churchill Livingstone, USA 6th ed, 2005; 2589-637.
- Hollingsworth JM, Birkmeyer JD, Ye Z, Miller DC. Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms. Surg Innov. 2014; 21 (6): 560-5.
- Gül R, Göksu S, Mızrak A, Koruk S, Öner Ü. Günübirlik cerrahi ünitemizde ilk sekiz aylık uygulamalarımız. Gaziantep Tıp. Dergisi 2008; 14 (2): 23-7.
- Friedman Z, Chung F, Wong DT, Canadian Anesthesiologists' Society. Ambulatory Surgery Adult Patient Selection Criteria - A Survey of Canadian Anesthesiologists. Can J Anaesth. 2004; 51 (5): 437-43.
- Ansell GL, Montgomery JE. Outcome of ASA III Patients Undergoing Day Case Surgery. Br J Anaesth. 2004; 92 (1): 71-4.
- Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999; 89 (6): 1352-9.
- Williams BA, Beaman ST, Kentor ML. Regional anesthesia group practice in the university hospital setting and ambulatory/regional anesthesia Clinical pathway formulation. Int Anesthesiol Clin. 2005; 43 (3):3-13.
- Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005; 101 (6): 1634-42.
- Klein SM, Pietrobon R, Nielsen KC, Warner DS, Greengrass RA, Steele SM. Peripheral nerve blockade with long-acting local anesthetics: a survey of the Society for Ambulatory Anesthesia. Anesth Analg. 2002; 94 (1): 71-6.
- Mezei G, Chung F. Return hospital visits and hospital readmissions after ambulatory surgery. Ann Surg.1999; 230 (5): 721-7.
- Twersky R, Fishman D, Homel P. What happens after discharge? Return hospital visits after ambulatory surgery. Anesth Analg.1997; 84 (2): 319-24.
- Warner MA, Shields SE, Chute CG. Major morbidity and mortality within 1 month of ambulatory surgery and ansthesia. JAMA 1993; 270 (12): 1437-41.
- Coley KC, Williams BA, DaPos SV, Chen C, Smith RB. Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. J Clin Anesth. 2002; 14 (5): 349-53.
- Junger A, Klasen J, Benson M, et al. Factors determining length of stay of surgical day-case patients. Eur J Anaesthesiol. 2001; 18 (5): 314-21.
- Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997; 85 (4): 808-16.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Aralık 2021 |
| Gönderilme Tarihi | 6 Mart 2021 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 60 Sayı: 4 |
