Ambulatory Surgery Program Research Articles

CYSTIC INGUINAL LYNFHANGIOMA IN ADULT FEMALE

Abstract Background To present a clinical case of cystic inguinal lymphangioma in an adult female, an atypical site and age of presentation. Method A 42-year-old woman was referred for consultation due to persistent pain and swelling in the right inguinal region, with initial suspicion of inguinal hernia. A mobile, irreducible mass without protrusion during the Valsalva maneuver was identified. Faced with diagnostic uncertainty, inguinal ultrasound and magnetic resonance imaging were requested, revealing a cystic lesion indicative of cystic inguinal lymphangioma. Results Elective surgery was decided. A right inguinal incision revealed a cystic tumor extending along the inguinal canal from the labium majus to the preperitoneal space. Complete excision was performed, requiring section of the round ligament. Subsequently, closure of the deep inguinal ring was conducted, with the conjoint tendon approximated to the inguinal ligament using a continuous suture of slowly absorbable monofilament. Hernioplasty with self-adhesive polypropylene mesh was employed to repair the inguinal defect. The procedure was carried out in the ambulatory major surgery program. At the one-month post-surgery follow-up, the patient exhibited satisfactory recovery with no signs of clinical recurrence. Histopathological examination of the surgical specimen confirmed the diagnosis of cystic inguinal lymphangioma, with no additional pathological findings. Conclusion Cystic lymphangioma is a benign and uncommon malformation of the lymphatic system. It should be considered in cases of inguinal masses with progressive growth whose examination is not consistent with an inguinal hernia. Ultrasound is the imaging test of choice, with definitive diagnosis confirmed by histopathology. Surgery with complete resection is recommended due to the risk of recurrence.

Ambulatory Cholecystectomy in the COVID-19 Era: Safety of a Major Outpatient Surgery Program in Pandemic

Since the Coronavirus disease 2019 (COVID-19) pandemic, elective surgery decreased substantially. On the other hand, a delay in the treatment of cholelithiasis in Chile leads to a significant morbidity, making surgical intervention essential. In this scenario, we performed the present study with the aim of defining if a major ambulatory surgery program is safe in the COVID-19 era. We included patients operated of ambulatory laparoscopic cholecystectomy between August 2020 and February 2021 in a hospital center in Santiago de Chile, during the peak of the COVID-19 pandemic, with an average PCR positivity rate of 6% and an ICU bed occupancy rate >80% in that period. Prospective data were collected to include baseline demographics, operative procedure and 30-day post-operative outcomes. A total of 109 cholecystectomies were performed, with a majority ASA I-II (American Society of Anaesthesiologists), in patients with cholelithiasis. 98.2% were completed laparoscopically, with a 17,4% rate for vesicular perforation. Thirty day follow-up revealed a complication rate of 44%, with 16,5% of patient having diarrhea and 17,4% abdominal pain. Only 2 patients (1.8%) developed COVID-19 symptoms postoperatively. 15.6% of patients attended the emergency department in the 30-day postoperative period. Early discharge was feasible in all patients. Our study demonstrates that an ambulatory cholecystectomy program during the COVID-19 pandemic can be carried out safely and effectively. Complications evidenced are in agreement with the reported literature, with a caveat of careful patient selection. We demonstrated that ambulatory surgery is feasible during pandemic, with a low incidence of COVID-19 infection, and without mortality.

Analysis of satisfaction and surgical outcomes of a major ambulatory surgery program for penile implant

Introduction and objectivePenile prosthesis (PP) surgery is performed in many institutions as an inpatient procedure. We have recently initiated a major ambulatory surgery (MAS) program, thus reducing the hospital stay.The objective of this study was to assess the feasibility, complications and satisfaction of the implantation of outpatient surgery PP program in our hospital. Material and methodsRetrospective observational study evaluating the results and satisfaction of PP implanted as an outpatient procedure in Bellvitge University Hospital during 2018. ResultsDuring 2018 we implanted 49 PP: 27 (55%) inpatient surgeries vs. 22 (45%) outpatient surgeries. Of these 22, 2 (9%) were second implants. All patients underwent both general anesthesia and crural, proximal dorsal nerve and transversus abdominis plane block (TAP). Complication rates between inpatient and outpatient procedures were similar, 2 (7%) and 1 (5%), respectively, without reporting infections or requiring PP removal.Postoperatively, a satisfaction telephone survey was conducted in 19 (86%) patients: 16 (84%) considered the time of hospital stay as appropriate, 15 (79%) would have preferred to be operated again in an outpatient care setting and 15 (79%) would recommend it. The patients’ main concerns were related to being at home with no medical assistance at home and about coming back the next day for drainage removal. All patients reported well-controlled pain without requiring opioid intake in any case. ConclusionsIn our series, PP implantation in an ambulatory care setting is feasible and safe. Although there are some aspects that should be improved, the program showed acceptable satisfaction rates and an adequate postoperative pain control, neither raising the administration of opioids, nor increasing complications and re-admission rates.

Análisis de satisfacción y resultados quirúrgicos de un programa de cirugía mayor ambulatoria para el implante de prótesis de pene

Introduction and objectivePenile prosthesis (PP) surgery is performed in many institutions as an inpatient procedure. We have recently initiated a major ambulatory surgery (MAS) program, thus reducing the hospital stay.The objective of this study was to assess the feasibility, complications and satisfaction of the implantation of outpatient surgery PP program in our hospital. Material and methodsRetrospective observational study evaluating the results and satisfaction of PP implanted as an outpatient procedure in Bellvitge University Hospital during 2018. ResultsDuring 2018 we implanted 49 PP: 27 (55%) inpatient surgeries vs. 22 (45%) outpatient surgeries. Of these 22, 2 (9%) were second implants. All patients underwent both general anesthesia and crural, proximal dorsal nerve and transversus abdominis plane block (TAP). Complication rates between inpatient and outpatient procedures were similar, 2 (7%) and 1 (5%), respectively, without reporting infections or requiring PP removal.Postoperatively, a satisfaction telephone survey was conducted in 19 (86%) patients: 16 (84%) considered the time of hospital stay as appropriate, 15 (79%) would have preferred to be operated again in an outpatient care setting and 15 (79%) would recommend it. The patients’ main concerns were related to being at home with no medical assistance at home and about coming back the next day for drainage removal. All patients reported well-controlled pain without requiring opioid intake in any case. ConclusionsIn our series, PP implantation in an ambulatory care setting is feasible and safe. Although there are some aspects that should be improved, the program showed acceptable satisfaction rates and an adequate postoperative pain control, neither raising the administration of opioids, nor increasing complications and re-admission rates.

Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program

Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure with low morbidity. The definition of risk factors for postoperative complications would help to identify the patients likely to require more care and surveillance in an ambulatory or 1-day surgery (A-OdS) program. The main endpoints are overall 30-day morbidity and relevant morbidity. The secondary objectives are to detect risk factors for complications, rehospitalization, and the time of occurrence of the postoperative complications, and to describe the adverse effects following hospitalization that the A-OdS program would avoid. This is an observational study of consecutive patients undergoing TEM between June 2004 and December 2016. Overall and relevant morbidity based on the Clavien-Dindo (Cl-D) classification were recorded, as were demographic, preoperative, surgical, and pathology variables. Univariate and multivariate analyses of the risk factors were carried out. Six hundred and ninety patients underwent surgery, of whom 639 were included in the study. Overall morbidity rate was 151/639 patients (23.6%); the clinically relevant morbidity rate was 36/639 (Cl-D > II) (5.6%) and mortality 2/639 (0.3%). The most frequent complication was rectal bleeding, recorded in 16.9% (108/639 patients) and grade I in 86/108 patients (78. 9%). The period with the greatest risk of complications was the first 2days. The rehospitalization rate after 48h was 7%. The risk factors for complications were as follows: tumor size > 6cm (OR 3.2, 95% CI 1.3-7.8), anti-platelet medication (OR 2.3, 95% CI 1.1-5.1), and surgeon's experience < 150 procedures (OR 2.0, 95% CI 1-4.1). TEM is a safe procedure. The low rates of morbidity, re-hospitalization, and postoperative complications in the first 2days after surgery make the procedure suitable for A-OdS.

Long Term Follow-Up In Feminine Stress Urinary Incontinence Ambulatory Surgery By Using A Single Incision Transobturator Mesh

Objective: To evaluate short and long-term results obtained from ambulatory surgical treatment of feminine stress urinary incontinence (SUI), by using a transobturator mesh (TOT) and a single Contasure-Needleless incision (Neomedic-International).Patients and Method: Between January 2007 and December 2015, 215 patients suffering from SUI received surgery under local anaesthesia and strict ambulatory regime, by placing a Needleless suburethral sling without tension. We evaluated all the inclusion criteria and both long and short-term results. Every patient underwent a bladder stress test, a urodynamic study and a quality of life questionnaire (ICIQSF) before and after the procedure. Later, they were followed up by means of annual reviews until December 2016. Results: Tolerance to the surgical procedure was satisfactory and duration was in all cases less than 10 minutes, hospital stay until discharge was always inferior to 2 hours. The results we obtained in short, medium and long term are comparable to the ones achieved with epidural anaesthesia. Hospitalisation and level of postoperative satisfaction was very high as well.Conclusion: Almost all patients affected by this problem are good candidates to be included in an ambulatory surgery program, improving ostensibly cost-effectiveness without any repercussion on the quality of care or satisfaction degree and giving excellent and long-lasting results, both medium and long term.

Anesthesia for Ambulatory Pediatric Surgery in Sub-Saharan Africa: A Pilot Study in Burkina Faso.

Long surgical wait times and limited hospital capacity are common obstacles to surgical care in many countries in Sub-Saharan Africa (SSA). Introducing ambulatory surgery might contribute to a solution to these problems. The purpose of this study was to evaluate the safety and feasibility of introducing ambulatory surgery into a pediatric hospital in SSA. This is a cross-sectional descriptive study that took place over 6 months. It includes all patients assigned to undergo ambulatory surgery in the Pediatric University Hospital in Ouagadougou, Burkina Faso. Eligibility criteria for the ambulatory surgery program included >1 year of age, American Society of Anesthesiologists (ASA) 1 status, surgery with a low risk of bleeding, lasting <90 minutes, and with an expectation of mild to moderate postoperative pain. The family had to live within 1 hour of the hospital and be available by telephone. During the study period, a total of 1250 patients underwent surgery, of whom 515 were elective cases; 115 of these met the criteria for ambulatory surgery; 103 patients, with an average age of 59.74 ± 41.57 months, actually underwent surgery. The principal indications for surgery were inguinal (62) and umbilical (47) hernias. All patients had general anesthesia with halothane. Sixty-five percent also received regional or local anesthesia consisting of caudal block in 79.23% or nerve block in 20.77%. The average duration of surgery was 33 ± 17.47 minutes. No intraoperative complications were noted. All the patients received acetaminophen and a nonsteroidal anti-inflammatory drug in the recovery room. Twelve (11.7%) patients had complications in recovery, principally nausea and vomiting. Eight (7.8%) patients were admitted to the hospital. No serious complications were associated with ambulatory surgery. Its introduction could possibly be a solution to improving pediatric surgical access in low-income countries.

Tratamiento quirúrgico ambulatorio del cáncer de mama. Experiencia en el Hospital General de Ciudad Real

ObjectiveTo describe the series of patients diagnosed with breast cancer that went to the operation room in the Ambulatory Surgery Program in the University General Hospital of Ciudad Real. Patients and methodsRetrospective descriptive study of patients diagnosed of breast cancer in University General Hospital of Ciudad Real and had been operated between 01-01-2010 to 01-02-2011. Results130 patients were analyzed. 20% were considered long stay more than 72hours, 32,3% were short stay and 47,7% were ambulatory surgery. Conservative surgery were performed in 69,4% of all the cases included. ConclusionBreast cancer surgery is feasible in ambulatory surgery programs with patients selection criteria. Conservative techniques were the most common surgery in our program.

¿Es la obesidad un factor de riesgo de complicaciones, ingresos y suspensiones quirúrgicas en cirugía mayor ambulatoria?

ObjectivesTo determine the incidence of outcomes, unanticipated admissions and cancellations in patients operated in an Ambulatory surgery unit, and to establish the relationships with their body mass index (BMI). Subjects and methodsAn observational descriptive prospective study was conducted in the Ambulatory surgery unit of the University Hospital Virgen del Rocío of Seville, on ASA I or II adult patients proposed for day case surgery with loco-regional or general anesthesia. A cohort of 1,088 patients was classified according to their body mass index into four groups: no obesity (BMI<30), obesity i (BMI 30-34.9), obesity ii (BMI 35–39.9), and morbid obesity iii (BMI 40-49.9). Postoperative outcomes (48h), inpatient admissions, and cancellations where calculated. ResultsThe obesity ii (BMI 35-39.9) group showed a higher incidence of postoperative complications (7.69%), unplanned admissions (7.69%), and surgical cancellations (4.87%), doubling, at least, the incidence of adverse events of the other study groups, even when no significant difference was found. Outcomes where similar in all study groups. ConclusionsThe results of this study suggest that moderate and severe obesity should be a risk factor for postoperative complications, unplanned admissions, and cancellations in outpatient surgery. Adequate patient selection and preoperative evaluation, as well as strategies for the prevention and control of the most frequents complications in obese patients are the key factors for their integration in major ambulatory surgery programs.

Results of the First 100 Single Port Laparoscopic Cholecystectomies in a Secondary Care Hospital

IntroductionDespite the excellent results obtained with standard laparoscopic cholecystectomy, the efforts for minimizing the ports needed to reduce postoperative pain, for a quicker recovery and to improve the patient's cosmetics continue. The aim of this study is to report the results of the first 100 cases of single port laparoscopic cholecystectomy performed in a secondary care hospital. Material and methodsProspective, observational and unicentric study including 100 patients between January 2010 and April 2012. Inclusion criteria: symptomatic cholelythiasis patients over 16 years of age on whom a single port laparoscopic cholecystectomy was performed. Exclusion criteria: history of acute cholecystitis, pancreatitis or suspected choledocholithiasis, Endoscopic retrograde cholangiopancreatography, BMI>35 and previous laparotomies. We studied epidemiological, surgical and safety variables. ResultsThe mean patient age was 39.89±11.5 years. The mean time of the surgical procedure was 67.94±25.5min. There were 2 cases of postoperative complications: a non-infected seroma and a biliar leak. In 2 cases the use of an accessory trocar was needed. The mean hospital stay was 1.13±0.8 days. A total of 35% patients were included in the major ambulatory surgery program. The overall patient satisfaction survey rating showed a high level of cosmetic satisfaction in 100% of patients. ConclusionsSingle port laparoscopic cholecystectomy is a good technique when performed in selected cases by expert surgeons. It is feasible to include the single port laparoscopic cholecystectomy in a major ambulatory surgery program. We have not had serious complications. There is a high cosmetic satisfaction index with this technique.

Cost-effectiveness of a hallux valgus day-surgery program

IntroductionThe development of one-day surgery units has shown to be a better use of health resources without reducing quality. The objective of this study was to evaluate the effectiveness and quality criteria of ambulatory surgery program in the hallux valgus process. Materials and methodsA retrospective study was conducted on a sample of 754 patients who underwent a hallux valgus process at our institution between 2002 and 2012. PatientsThe cost-process was evaluated using the Weighted Care Unit (WCU) as a measuring unit. Secondary data were collected as regards discharge criteria and patient satisfaction. ResultsA significant difference was found between WCU spending on in-patient surgery and out-patient surgery. Both samples were comparable and no differences were found between diagnosis and intervention. The admission rate after ambulatory surgery was 2.29%, and the substitution index increased to 56.04%. The ambulatory surgery program was given a satisfaction rating of 84.6 out of 100. ConclusionsThe results of our study indicate that it is possible to maximise the substitution index of the hallux valgus process leading to a better use of resources and a high degree of patient satisfaction.

Coste-efectividad del proceso hallux valgus en cirugía mayor ambulatoria

IntroductionThe development of one-day surgery units has shown to be a better use of health resources without reducing quality. The objective of this study was to evaluate the effectiveness and quality criteria of ambulatory surgery program in the Hallux valgus process. Material and methodsA retrospective study was conducted on a sample of 753 patients who underwent a Hallux valgus process at our institution between 2002 and 2012 (292 in ambulatory surgery cohort and 461 in hospitalization group). The cost-process was evaluated using the Weighted Care Unitas a measuring unit. Secondary data were collected as regards discharge criteria and patient satisfaction. ResultsA significant difference was found between Weighted Care Unit spending on in-patient surgery and out-patient surgery. Both samples were comparable and no differences were found between diagnosis and intervention. The admission rate after ambulatory surgery was 2.39%, and the substitution index increased to 56.04%. The ambulatory surgery program was given a satisfaction rating of 84.6 out of 100. ConclusionsThe results of our study indicate that it is possible to maximize the substitution index of the Hallux valgus process leading to a better use of resources and a high degree of patient satisfaction.

Single-Incision Laparoscopic Cholecystectomy for Day Surgery Procedure: Are We Prepared?

Single-incision laparoscopic surgery (SILS) for cholecystectomy is a well-established procedure and represents the next step in developing the concept of fast track surgery. This report describes our experience with SILS cholecystectomy in patients that stay overnight. Between February 2009 and July 2010, patients referred for cholecystectomy to the day surgery unit who agreed to undergo SILS were included in a prospective study. All operations were performed by the same surgical team specially trained in this type of surgery and the same operative technique was used in all cases. Postoperative pain and nausea were assessed using a 10-cm visual analogue scale on a self-completion questionnaire on the night of operation and the morning of discharge. A total of 107 patients (58% women, mean age 56 years) with symptomatic gallstones were included in the study. SILS was successfully performed in all patients and no patient required conversion to an open procedure. There were no significant differences in the median visual analogue scale for postoperative pain and nausea between the night of surgery and the next morning. The mean length of hospital stay was 23 hours, and 98 per cent of patients were satisfied with the results of surgery and would be willing to undergo the same procedure again. SILS cholecystectomy is a valid alternative to standard laparoscopic cholecystectomy as an outpatient surgery or overnight stay procedure. According to these promising results, SILS cholecystectomy could be included in a major ambulatory surgery program.

A Twelve-Year Experience in Ambulatory Surgery within Urology.

Purpose. The aim of this study is to show you the results we obtained through the integration of the Urology Department into the Ambulatory Surgery Unit for the very first twelve years. Scope. We will explain both the criteria we followed for patients to join in and the surgical and anesthetic procedures we used with those 1544 patients who were ambulatory subjected to urological diseases. After those patients were treated, they reached up to 95% of reasonable results. Conclusions. Most of urological patients liable to have surgical treatment are bound to be included in an ambulatory surgery program, which implies neither a worse healthcare service standard nor a worse satisfaction in patients.

Video-Assisted Thoracoscopic Lung Biopsy in the Diagnosis of Interstitial Lung Disease: A Prospective, Multi-Center Study in 224 Patients

ObjectivesTo evaluate whether the location and number of lung biopsies obtained by video-assisted thoracoscopy (VAT) influence the diagnosis of diffuse interstitial lung disease (ILD). To assess the applicability of an ambulatory surgery program (ASP). MethodsProspective, multicenter study of VAT lung biopsies due to suspected ILD from January 2007 to December 2009, including 224 patients from 13 Spanish centers (mean age 57.1 years; 52.6% females). Data were prospectively collected in every institution and sent to the coordination center for analysis. ResultsThe most affected areas in high-resolution chest CT were the lower lobes (55%). Bronchoscopy was performed in 84% and transbronchial biopsy in 49.1%. In 179 cases (79.9%), more than one biopsy was performed, with a diagnostic agreement of 97.2%. A definitive histopathologic diagnosis was obtained in 195 patients (87%). Idiopathic pulmonary fibrosis was the most frequent diagnosis (26%). There were no statistically significant factors that could predict a greater diagnostic yield (neither anatomical location nor number of biopsies). Seventy patients (31.3%) were included in an ASP. After discharge, there were complications in 12 patients (5.4%), similar between patients admitted postoperatively (9/154: 5.8%) and those included in an ASP (3/70: 4.3%). ConclusionsAnatomical location and number of lung biopsy specimens did not seem to influence the diagnosis. The patients included in an ASP had a complication rate comparable to that of the hospitalized, so this procedure can be included in a surgical outpatient program. Lung biopsy obtained by VAT is a powerful and safe tool for diagnosis of suspected ILD, resulting in a definitive diagnosis for the majority of patients with a low morbidity rate.

Biopsia pulmonar por videotoracoscopia en el diagnóstico de la enfermedad pulmonar intersticial. Estudio prospectivo y multicéntrico en 224 pacientes

ObjectivesTo evaluate whether the location and number of lung biopsies obtained by video-assisted thoracoscopy (VAT) influence the diagnosis of diffuse interstitial lung disease (ILD). To assess the applicability of an Ambulatory Surgery Program (ASP). MethodsProspective, multicenter study of VAT lung biopsies due to suspected ILD from January 2007 to December 2009, including 224 patients from 13 Spanish centers (mean age 57.1 years; 52.6% females). Data were prospectively collected in every institution and sent to the coordination center for analysis. ResultsThe most affected areas in high resolution chest CT were the lower lobes (55%). Bronchoscopy was performed in 84% and transbronchial biopsy in 49.1%. In 179 cases (79.9%), more than one biopsy was performed, with a diagnostic agreement of 97.2%. A definitive histopathologic diagnosis was obtained in 195 patients (87%). Idiopathic pulmonary fibrosis was the most frequent diagnosis (26%). There were no statistically significant factors that could predict a greater diagnostic yield (neither anatomical location nor number of biopsies). Seventy patients (31.3%) were included in an ASP. After discharge, there were complications in 12 patients (5.4%), similar between patients admitted postoperatively (9/154: 5.8%) and those included in an ASP (3/70: 4.3%). ConclusionsAnatomical location and number of lung biopsy specimens did not seem to influence the diagnosis. The patients included in an ASP had a complication rate comparable to that of the hospitalized, so this procedure can be included in a surgical outpatient program. Lung biopsy obtained by VAT is a powerful and safe tool for diagnosis of suspected ILD, resulting in a definitive diagnosis for the majority of patients with a low morbidity rate.

Results of a major ambulatory oral surgery program using general inhalational anesthesia on disabled patients

To assess the demographic characteristics and comorbidities of the group to be studied, as well as various quality indicators of a Major Ambulatory Surgery (MAS) program. Quantification of the surgical-anesthetic incidents. We aimed to perform a retrospective and descriptive analysis of disabled patients who had received oral ambulatory surgery under general anesthesia. Data obtained from the clinical history and telephone interview included the demographic characteristics, socioeconomic status, previous dental history, cause of the mental disability, degree of mental retardation, comorbidity measured according to the scale of the American Society of Anesthesiologists (ASA), anesthesia or preoperative surgical treatments, level of analgesia, length of stay, incidents in the Resuscitation Ward, the rate of substitution, suspensions, patients admitted, complications and the degree of patient satisfaction. We included 112 oral surgery procedures performed on disabled patients who were treated under general inhalational anesthesia as part of MAS during the years 2006-2007. During this period, 577 restorations, 413 extractions, 179 sealants, 102 pulpectomies, 22 root canal treatments, 17 gingivectomies and 3 frenectomies were performed. A total of 75% (78 cases) of the patients had coexisting medical pathology. The average surgery time per patient was 72.69 +/- 29.78 minutes. The rate of replacement was 100%. The rate of suspension was 1.92%. The percentage of patients readmitted was 1.92%,due to significant bleeding in the mouth, which did not require treatment and the patients were discharged from hospital 24 hours after being admitted. The rate of patients who required re-hospitalization was 3.84%. The MAS performed in this group, despite being on patients with high comorbidity resulted in only a low number of medical incidents reported.

Resultados de la simpaticotomía videotoracoscópica en el tratamiento del rubor y la hiperhidrosis facial en 41 pacientes

To evaluate the results and complications of thoracic sympathectomy in the treatment of patients with uncontrollable blushing and facial hyperhidrosis. Between May 2000 and August 2006 we performed 82 VATS sympathectomies on 41 patients with the diagnosis of uncontrollable blushing and/or facial hyperhidrosis. Two of them had been previously operated on without good results. The technique employed was bilateral VATS sympathectomy varying the levels depending on the presence of palmar and/or axillary hyperhidrosis and the anatomical limitations. The results were evaluated one week after the procedure and 3-6 months later in 41 patients; and also one year later in 34 patients. Twenty-two men and 19 women, with mean age of 33.7 years (range, 18-56). In 17 patients (41.5%) main symptom was facial hyperhidrosis and in 24 (58.5%) uncontrollable blushing. All the patients were discharged before 24 hours after surgery, 14 of them in an ambulatory surgery program. There was improvement of the symptoms in all the cases of facial hyperhidrosis 17/17 (100%). In the blushing group the procedure was effective in 20/24 cases (83.3%). Results were good with the second surgery. Compensatory sweating was observed in 16/41 patients (39%), and was severe in 6 (14.6%). Sympathectomy is a safe and effective procedure in the management of facial hyperhidrosis and uncontrollable blushing. Compensatory sweating remains as the main secondary effect.

Análisis de los reingresos hospitalarios domiciliarios en un programa de cirugía mayor ambulatoria

To quantify readmission rates due to both major and minor complications per year of study in an ambulatory surgery program and to assess the effect of including patients with greater severity on the results.We performed a retrospective study of patients undergoing surgery in an ambulatory surgery program in our health center between 1998 and 2003. During the study period, 25,553 patients met the selection criteria for elective ambulatory surgery. To analyze the evolution of complications over the study period, the first year of the study period was taken as the reference, and the chi(2) test was used to measure tendency, obtaining annual odd ratios (OR) and their respective confidence intervals.The substitution index in the study period was 55.25%. The proportional risk of a major complication in our series was 1:426. The number of patients readmitted from home represented 0.83% of the total number of patients undergoing ambulatory surgery. The most common causes of readmission were surgically-related occurrences, mainly bleeding from the surgical site. Most complications were minor, the most frequently found problem being pain in the surgical wound.Safety is an attitude and when the surgeon and the anesthesiologist apply appropriate patient selection criteria and perform a careful preanesthesia evaluation, there is no reason to expect more complications in ambulatory patients than in inpatients.

Resultados de un programa de cirugía mayor ambulatoria en oftalmología

To evaluate the outcomes in our hospital of an ambulatory major surgery program in patients with a variety of different ocular pathologies. 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. 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 complications (cardiovascular, neurological, metabolic, infectious), representing a proportional risk of 1:532. Forty-five patients had less severe complications (arterial hypertension, nausea, vomiting, vasovagal syncope) that required admission to hospital. Ophthalmologic complications occurred in 79 cases (0.56%). Ambulatory major surgery (AMS) is an excellent organization model of multidisciplinary surgical assistance that makes it possible to treat well selected patients in an effective, safe and efficient manner. There is a low incidence of postoperative complications of variable severity despite following the optimum requisites, although fortunately mortality is practically absent.