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Outpatient Surgery Benchmarks and Practice Variation Patterns: Case Controlled Study

International journal of surgery (London, England)(2024)

Mayo Clin Arizona | Mayo Clin Rochester | Mayo Clin Florida | 200 First St SW

Cited 0|Views20
Abstract
Background:Despite numerous potential benefits of outpatient surgery, there is currently a lack of national benchmarking data available for hospitals and surgeons to compare their own outcomes as they transition toward outpatient surgery. Materials and methods:Patients who underwent 14 common general surgery operations from 2016 to 2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Operations were selected based on frequency and the ability to be performed both inpatient and outpatient. Postoperative complications and readmissions were compared between patients who underwent inpatient vs outpatient surgery. After adjusting for patient comorbidities, multivariable models assessed the effect of patient characteristics on the odds of experiencing postoperative complications. A separate multi-institutional study of 21 affiliated hospitals assessed practice variation. Results:In 13 of the 14 studied procedures, complications were lower for patients who were selected for outpatient surgery (all P<0.01); minimally invasive (MIS) adrenalectomy showed no difference (P=0.61). Multivariable analysis confirmed these findings; the odds of experiencing any adverse events were lower following outpatient surgery in all operations but MIS adrenalectomy (OR 0.97; 95% CI: 0.47-2.02). Analysis of institutional practices demonstrated variation in the rate of outpatient surgery in certain breast, endocrine, and hernia repair operations. Conclusions:Institutional practice patterns may explain the national variation in the rate of outpatient surgery. While the present data does not support the adoption of outpatient surgery to less optimal candidates, addressing unexplained practice variations could result in improved utilization of outpatient surgery.
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Key words
ambulatory surgery,NSQIP,outpatient surgery,postoperative complications,readmissions
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要点】:研究开发并评估了一种自动化内镜工具插入和传递设备“INSERTrument”,以减少内镜医师在操作过程中经历的 ergonomic strain,并显著降低手腕动作和不良姿势的风险。

方法】:通过在猪模型上进行活体胃内镜下黏膜剥离术(ESD),并由两位经验丰富的内镜医师操作,使用惯性测量单位(IMUs)来客观分析手腕关节角度,对比评估了INSERTrument与传统手动方法。

实验】:在活体猪模型上进行了ESD操作实验,使用的数据集包括手腕关节角度的IMU数据。实验结果显示,INSERTrument在每次工具交换和整个ESD过程中显著减少了手腕的快速摆动次数和不良姿势的时间百分比,同时减少了工具交换的总时间。