scholarly journals Impact of Ambulatory Surgery for Hemorrhoidal Disease on Clinical Outcomes and Institutional Costs

2021 ◽  
Vol 41 (01) ◽  
pp. 014-022
Author(s):  
Simona Ascanelli ◽  
Stefano Solari ◽  
Michele Rubbini ◽  
Filippo Aisoni ◽  
Maria Elena Forini ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Return To Work ◽  
Local Anesthesia ◽  
Ambulatory Surgery ◽  
Hemorrhoidal Disease ◽  
Daily Activities ◽  
Ambulatory Setting ◽  
Hemorrhoidal Artery Ligation ◽  
Group A ◽  
The Impact

Abstract Objective Transanal hemorrhoidal artery ligation with mucopexy (ligation anopexy [LA]) and open hemorrhoidectomy (OH) can both be performed under local anesthesia. The aim of the present study was to analyze the impact and the cost-effectiveness of performing these techniques in an ambulatory setting of an Italian academic center on the postoperative outcome. Methods A series of 122 consecutive patients with grades II and III hemorrhoidal disease undergoing ambulatory surgical treatment of hemorrhoids in 2015 to 2018 (group A) was compared with 122 patients operated at the same institution in the same period (group H) in a hospital setting.The primary outcome was the number of days required to return to work/daily activities. Secondary outcomes included postoperative pain and complications, cost-effectiveness, patient satisfaction, and recurrence at 12 months. In group A, all the procedures were performed under local anesthesia with early discharge. In group H, the procedures were performed under general or loco-regional anesthesia with hospital admission. Results The mean number of days required to return to work/daily activities was 8.4 ± 4.8 days in group A, compared with 12.5 ± 3 days in group H (p < 0.001). The visual analog scale (VAS) pain score at 1 week, 2 and 3 weeks, and 1 month after surgery was lower for patients undergoing LA in the ambulatory setting (p < 0.01). We observed more postoperative complications in hospitalized (12.5%) than in ambulatory patients (7.5%) (p < 0.001). The total mean direct costs per patient were significantly lower in the ambulatory setting versus the hospital stay group (351.3 versus 1,746 euros). Conclusion Implementing ambulatory surgery for hemorrhoids is feasible, safe, and cost-effective.

scholarly journals The Impact of Pain Control on Invasive Clinical Procedure on Children with Leukemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5827-5827
Author(s):  
Jiayi WANG ◽  
Yingyi He ◽  
Zhimin Liang ◽  
Tiezhen Ye ◽  
Hui Zhang
Keyword(s):  
Local Anesthesia ◽  
Pain Control ◽  
Adverse Reactions ◽  
Low Dose ◽  
Invasive Procedure ◽  
Anesthesia Group ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Group D

Abstract Background: Palliative care is becoming more and more important for systemic cancer treatment in developed countries, while this remains infamous topic in developing countries, such as in China. Contemporary treatment strategies have greatly contributed to the improved outcome in childhood cancer patients, survivorship comes at the cost of developing some treatment-related health condition, such as pain-related depression, chronic pain etc. Thus, developing a well-tolerated pain control methods is of great importance within the cancer treatment. Objective: To evaluate the impact and outcome of different pain control applications on invasive procedure in children with leukemia, and record the adverse reactions. Methods: The enrollment of childhood leukemia patients in our hospital from November 2011 to November 2016 were divided into four groups, that is successively midazolam + local anesthesia (group A), midazolam + ketamine +local anesthesia (group B), midazolam + fentanyl + local anesthesia (group C), and fentanyl + propofol + local anesthesia (group D). The efficacy and adverse reactions were systemically recorded. The inter-group diffferences were calculated using x2 test. Results: No significancewas observed in age, gender, and disease distribution in these four groups by ANOVA ONEWAY analysis. The sedation outcome is more pronunced in group D than others. Also, the quality of procedural pain control in group D was the best (P<0.01). In terms of the analgesic effect, group B and D were better than that group A and C. There was significant difference in Hallucination was more easily detected in group B and C. Systemic recovery was delayed in group B other than group A, C, and D. Basing on the survey, we did found that the family members were more willing to accept pain control treatment for their sick kids under the safety assurance. The compliance was significantly improved in group D. Conclusion: Upon adequate auxiliary breathing preparation and rigorous monitor, propofol combined with low-dose fentanyl was the best sedative/analgesic option for pain control within leukemia patients receiving invasive procedure.The outcome of propofol combined with low-dose fentanyl wasvery safe, satisfactory and compliable. Up to now, this study is the first pain control study for invasive procedure in China mainland, it deserves being paid attention. Disclosures No relevant conflicts of interest to declare.

scholarly journals Impact of caregiver overnight stay on postoperative outcomes

2019 ◽  
Vol 33 (1) ◽  
pp. 18-26
Author(s):  
Susan Griffin ◽  
Leigh McGrath ◽  
Gregory T. Chesnut ◽  
Nicole Benfante ◽  
Melissa Assel ◽  
...  
Keyword(s):  
Ambulatory Surgery ◽  
Surgical Techniques ◽  
Postoperative Outcomes ◽  
Urgent Care ◽  
Ambulatory Setting ◽  
Complication Rates ◽  
Content Type ◽  
Overnight Stay ◽  
Number Of Patients ◽  
The Impact

Purpose The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes. Design/methodology/approach This was a retrospective cohort study of patients undergoing surgery requiring overnight stay in a highly resourced free-standing oncology ambulatory surgery center. Postoperative outcomes in patients who had caregivers stay with them overnight were compared with outcomes in those who did not. All other care was standardized. Primary outcomes were postoperative length of stay, hospital readmission rates, urgent care center (UCC) visits within 30 days and perioperative complication rates. Findings Among patients staying overnight, 2,462 (57 percent) were accompanied by overnight caregivers. In this group, time to discharge was significantly lower. Readmissions (though rare) were slightly higher, though the difference was not statistically significant (p=0.059). No difference in early (<30 day) complications or UCC visits was noted. Presence of a caregiver overnight was not associated with important differences in outcomes, though further research in a less well-structured environment is likely to show a more robust benefit. Caregivers are still recommended to stay overnight if that is their preference as no harm was identified. Originality/value This study is unique in its evaluation of the clinical impact of having a caregiver stay overnight with ambulatory surgery patients. Little research has focused on the direct impact of the caregiver on patient outcomes, especially in the ambulatory setting. With increased adoption of minimally invasive surgical techniques and enhanced recovery pathways, a larger number of patients are eligible for short-stay ambulatory surgery. Factors that impact discharge and early postoperative complications are important.

scholarly journals Effect of a Mobile App on Preoperative Patient Preparation for Major Ambulatory Surgery: Protocol for a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Manuel Herrera-Usagre ◽  
Vicente Santana ◽  
Ramon Burgos-Pol ◽  
Juan Pedro Oliva ◽  
Eliazar Sabater ◽  
...  
Keyword(s):  
Information Systems ◽  
Ambulatory Surgery ◽  
Intervention Group ◽  
Ambulatory Setting ◽  
Current Evidence ◽  
Control Group ◽  
Patient Preparation ◽  
Perceived Usability ◽  
The Impact ◽  
Preoperative Patient

BACKGROUND Inadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting. OBJECTIVE The objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC). METHODS A multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ≥18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group. RESULTS The technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019. CONCLUSIONS Progress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients’ preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability and utility of Listeo+ app among patients and health care professionals. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/10938

scholarly journals The Impact of Preoperative Warming of Ambulatory Surgery Patients on the Prevention of Postoperative Hyposthermia

2010 ◽  
Author(s):  
Mary Croft
Keyword(s):  
Ambulatory Surgery ◽  
Intervention Group ◽  
Surgical Patients ◽  
Ambulatory Setting ◽  
Control Group ◽  
Anesthesia Induction ◽  
Convenience Sample ◽  
Forced Air Warming ◽  
Number Of Patients ◽  
The Impact

<p>Postoperative hypothermia is a continuing problem in surgical patients. Preoperative warming has been shown to benefit patients undergoing major surgical procedures but studies are lacking in patients in the ambulatory setting.</p> <p>Objective: The purpose of this study was to explore the effect of warming ambulatory surgical patients preoperatively prior to anesthesia induction and surgery on maintenance of core body temperature, prevention of hypothermia in PACU, and patient comfort.</p> <p>Method: A convenience sample of96 adult patients undergoing ambulatory surgery was provided standard care (cotton bath blankets) <em>(n=4 </em><em>7) </em>or pre-warming (Bair Paws®Flex warming gown) <em>(n =49). </em>All patients received forced air warming intraoperatively.</p> <p>Results: The mean pre-warming time was 58.6 minutes. The intervention group mean temperatures were significantly improved (intervention mean 97.304 pre vs. 98.044 post; p = 0.002 vs. control mean 97.54 pre vs. 97.87 post; p = 0.063) upon discharge from the preoperative holding area and prior to transport to the OR surgical suite. There was a 0.13 degree F increase in mean core temperature to PACU in the pre-warmed group as compared to control (intervention means 97.66 vs. control mean 97.53; 95% CI). The control group had a mean temperature decrease of 0.01 F from preop temperature to PACU while the intervention groups' mean temperatures increased by 0.19° F. Seven patients in the control group arrived to PACU complaining of cold and one shivering, compared to one patient in the intervention group.</p> <p>Conclusions: Preoperative warming utilizing the Bair Paws® flex warming gowns increased patients' core temperatures on arrival to PACU and lessened the number of patients arriving to PACU complaining of cold.</p>

scholarly journals COST-EFFECTIVENESS ANALYSIS OF COUNSELING IN THERAPY FOR OUTPATIENTS WITH HYPERTENSION

2018 ◽  
Vol 11 (13) ◽  
pp. 18
Author(s):  
Diah Ramadhani ◽  
Urip Harahap ◽  
Azizah Nasution
Keyword(s):  
Cost Effectiveness ◽  
Health Care Providers ◽  
Cost Effective ◽  
Care Providers ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Quasi Experimental ◽  
Group A ◽  
The Cost ◽  
The Impact

 Objectives: To determine the effect of counseling on effectiveness and cost of the treatment for outpatient with primary hypertension (HTN) in Cut Meutia Hospital, Indonesia.Methods: This 6-month prospective quasi-experimental study was undertaken to analyze the impact of counseling toward cost and effectiveness in the treatment in patients with primary HTN and evaluation of each month at Cut Meutia Hospital, Indonesia. The study sample consisted of 22 patients for each group. A cost analysis was conducted from the perspective of the health-care providers. The cost in the treatment of both groups was analyzed by calculating the cost-effectiveness ratio (CER) and incremental CER (ICER).Results: Most of the patients with HTN (54.55%) were males with ages ranging from 35 to 64 years old (77.27%). Patients who achieved a blood pressure <140/90 mmHg on HTN treatment: With counseling, 77.27%; without counseling, 18.18%. CER for HTN treatment with and without counseling were Rp 1,756,117,86 and Rp 6,704,247,91, respectively. The ICER was Rp 233,745.13.Conclusion: Treatment of HTN with counseling was more cost-effective than without counseling.

Prompt Return to Work after Bilateral Transforaminal Full-endoscopic Lateral Recess Decompression under Local Anesthesia: A Case Report

2020 ◽  
Author(s):  
Kosuke Sugiura ◽  
Kazuta Yamashita ◽  
Hiroaki Manabe ◽  
Yoshihiro Ishihama ◽  
Fumitake Tezuka ◽  
...  
Keyword(s):  
Return To Work ◽  
Local Anesthesia ◽  
Skin Incision ◽  
Leg Pain ◽  
Lateral Recess ◽  
Canal Stenosis ◽  
Transforaminal Approach ◽  
Lateral Recess Stenosis ◽  
Lumbar Spinal ◽  
Herniated Nucleus Pulposus

AbstractTransforaminal full-endoscopic lumbar diskectomy became established early in the 21st century. It can be performed under local anesthesia and requires only an 8-mm skin incision, making it the least invasive disk surgery method available. The full-endoscopic technique has recently been used to treat lumbar spinal canal stenosis. Here, we describe the outcome of simultaneous bilateral decompression of lumbar lateral recess stenosis via a transforaminal approach under local anesthesia in a 60-year-old man. The patient presented with a complaint of bilateral leg pain that was preventing him from standing and walking, and he had been able to continue his work as a dentist by treating patients while seated. Imaging studies revealed bilateral lumbar lateral recess stenosis with central herniated nucleus pulposus at L4/5. We performed simultaneous bilateral transforaminal full-endoscopic lumbar lateral recess decompression (TE-LRD) under local anesthesia. Both decompression and diskectomy were successfully completed without complications. Five days after TE-LRD, he was able to return to work, and 3 months after the surgery, he resumed playing golf. Full-endoscopic surgery under local anesthesia can be very effective in patients who need to return to work as soon as possible after surgery.

ECONOMIC SUBSTANTIATION OF TRANSITION TO PERSONNEL OUTSOURCING IN THE ORGANIZATIONS OF THE CONSTRUCTION INDUSTRY

2020 ◽  
pp. 70-79
Author(s):  
V.V. Verna
Keyword(s):  
Cost Effectiveness ◽  
Construction Industry ◽  
Methodological Approaches ◽  
Construction Organization ◽  
The Cost ◽  
The Impact

The article provides a rationale for methodological approaches to assessing the effectiveness of outsourcing in organizations of the construction industry using the example of outsourcing schemes to perform personnel functions. The conditional example shows the impact of the use of outsourcing on reducing the costs of a construction organization. The main prerequisites for the use of outsourcing in the activities of enterprises in the construction industry are identified, methodological approaches to assessing the cost-effectiveness of personnel outsourcing in the construction industry enterprises are substantiated.

scholarly journals The impact and cost‐effectiveness of community‐basedHIVself‐testing in sub‐Saharan Africa: a health economic and modelling analysis

2019 ◽  
Vol 22 (S1) ◽  
pp. e25243 ◽  
Author(s):  
Valentina Cambiano ◽  
Cheryl C Johnson ◽  
Karin Hatzold ◽  
Fern Terris‐Prestholt ◽  
Hendy Maheswaran ◽  
...  
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Sub Saharan Africa ◽  
Modelling Analysis ◽  
Sub Saharan ◽  
The Impact

scholarly journals Patient-reported effectiveness and safety of Pamidronate in NSAIDs-refractory chronic recurrent multifocal osteomyelitis in children

2021 ◽  
Author(s):  
Bartłomiej Juszczak ◽  
Jerzy Sułko
Keyword(s):  
Adverse Drug Reactions ◽  
Social Life ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Daily Activities ◽  
Drug Reactions ◽  
Patient Reported ◽  
Multifocal Osteomyelitis ◽  
Drug Dependent ◽  
Treatment Onset ◽  
The Impact

AbstractTo evaluate patient-reported effectiveness, safety and social influence of Pamidronate in the therapy of NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis in children. Authors reviewed self-created questionnaires, which asked patients for symptoms alleviation, adverse drug reactions frequency and degree of severity and daily activities self-reliance. Only surveys with complete answers, which were returned to authors by an e-mail from juvenile patients treated for NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis at the University Children’s Hospital of Cracow were analyzed. Between 2010 and 2019, 61 children were diagnosed with NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis at our department. Out of 61 requests sent, 42 complete replies (33 females, 9 males) were gathered and analyzed. All patients included in this research were administered with at least one set of Pamidronate intravenously in the dose of 1 mg/kg/day for 3 consecutive days. Our analysis shows remarkable in terms of patient’s impressions decrease of pain intensity after 2.5 series of Pamidronate on average, and total pain resolution after 5.9 series on average. Overall number of adverse drug reaction events reported by responders was 105. One patient developed drug-dependent renal insufficiency in the course of therapy. Outcome assessment indicates that nearly 50% of the studied population was more eager to participate in social life just after the first infusion of the drug. 95% of the surveyed unanimously agreed to recommend Pamidronate therapy to cure NSAIDs-refractory CRMO. 39 out of 42 (93%) patients considered Pamidronate effective at the end of the treatment. Onset of Pamidronate’s action is gradual and differs in terms of symptoms alleviation between sexes. The therapy can induce considerable number of adverse drug reactions (2.5 per patient). Only 3 out of 42 (7%) patients were free from any ADRs. To demonstrate the impact of the use of Pamidronate on daily activities more precisely, further research with quantification of the quality of life is warranted.

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