• Neurospine
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• v.15 no.4
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• pp.376-382
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• 2018

Objective: The purpose of this study was to evaluate factors associated with inpatient admission following 2-level cervical disc arthroplasty (CDA). A secondary aim was to compare outcomes between those treated on an inpatient versus outpatient basis. Methods: Using data from the American College of Surgeons National Surgical Quality Improvement Program database, multivariate logistic regression analysis was used to assess the independent effect of each variable on inpatient or outpatient selection for surgery. Statistical significance was defined by p-values <0.05. The factors considered were age, sex, body mass index (BMI), smoking status, American Society of Anesthesiologists physical status classification, and comorbidities including hypertension, diabetes, history of dyspnea or chronic obstructive pulmonary disease, previous cardiac intervention or surgery, steroid usage, and history of bleeding. In addition, whether the operation was performed by an orthopedic or neurosurgical specialist was analyzed. Results: The number of 2-level CDA procedures increased from 6 cases reported in 2014 to 142 in 2016, although a statistically significant increase in the number of outpatient cases performed was not seen (p=0.2). The factors found to be significantly associated with inpatient status following surgery were BMI (p=0.019) and diabetes mellitus requiring insulin (p=0.043). There were no significant differences in complication and readmission rates between the inpatient and outpatient groups. Conclusion: Patients undergoing inpatient 2-level CDA had significantly higher rates of obesity and diabetes requiring insulin than did patients undergoing the same procedure in the outpatient setting. With no difference in complication or readmission rates, 2-level CDA may be considered safe in the outpatient setting in appropriately selected patients.

• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.380-389
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• 2023

Background: Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. Methods: A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. Results: One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39-90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. Conclusions: TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting. Level of evidence: IV.

• Journal of Chest Surgery
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• v.49 no.3
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• pp.185-189
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• 2016

Background: For treatment of pneumothorax in Korea, many institutions hospitalize the patient after chest tube insertion. In this study, a portable small-bore chest tube (Thoracic Egg; Sumitomo Bakelite Co. Ltd., Tokyo, Japan) was used for pneumothorax management in an outpatient clinic. Methods: Between August 2014 and March 2015, 56 pneumothorax patients were treated using the Thoracic Egg. Results: After Thoracic Egg insertion, 44 patients (78.6%) were discharged from the emergency room for follow-up in the outpatient clinic, and 12 patients (21.4%) were hospitalized. The mean duration of Thoracic Egg chest tube placement was 4.8 days, and the success rate was 73%; 20% of patients showed incomplete expansion and underwent video-assisted thoracoscopic surgery. For primary spontaneous pneumothorax patients, the success rate of the Thoracic Egg was 76.6% and for iatrogenic pneumothorax, it was 100%. There were 2 complications using the Thoracic Egg. Conclusion: Outpatient treatment of pneumothorax using the Thoracic Egg could be a good treatment option for primary spontaneous and iatrogenic pneumothorax.

• Journal of Yeungnam Medical Science
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• v.18 no.2
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• pp.145-169
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• 2001

In recent years, health care cost containment concerns have resulted in an increase in outpatient (or same-day) surgery. Many procedures previously performed on an inpatient surgery basis have been shifted to outpatient settings. Anesthesia for outpatient surgery is exactly the same as inpatient anesthesia, except that the primary concern is the selection of patients who can be discharged safely on the day of surgery. The anesthesiologist should have a sound rational basis for choice of pharmacologic agents that are geared to expeditious patient discharge from the hospital. Cost concerns aside, outpatient surgery has many additional advantages in the pediatric setting. It minimizes the length of time the child is hospitalized, decreases separation anxiety, promotes parental involvement in the child's postoperative care in the more congenial environment of home, and decreases risk of nosocomial infection and iatrogenic illness.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.3
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• pp.506-512
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• 1998

The dentists often encouter a child who can not be treated with traditional behavior management technique. Mentally or physically handicapped child could receive proper dental care under general anesthesia. General anesthesia for dental care can be done in an outpatient surgery or inpatient surgery depending on the patient. In outpatient surgery, the patient is admitted and discharged the same day. Postoperative care and discharge procedure are abbreviated. Advantages of outpatient surgery are much less emotional disturbance of patients, reduced risk of nosocomial infection and less cost of treatment. A case of a physically handicapped patient treated under general anesthesia at Day Surgery Center is presented and the procedure and patient selection of outpatient surgery as well as its limitation is reviewed in this paper.

• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.351-356
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• 2023

Background: Total elbow arthroplasty (TEA) is uncommon, but growing in incidence. Traditionally an inpatient operation, a growing number are performed outpatient, consistent with general trends in orthopedic surgery. The aim of this study was to compare TEA outcomes between inpatient and outpatient surgical settings. Secondarily, we sought to identify patient characteristics that predict the operative setting. Methods: Patient data were collected from the American College of Surgeons National Quality Improvement Program. Preoperative variables, including patient demographics and comorbidities, were recorded, and baseline differences were assessed via multivariate regression to predict operative setting. Multivariate regression was also used to compare postoperative complications within 30 days. Results: A total of 468 patients, 303 inpatient and 165 outpatient procedures, were identified for inclusion. Hypoalbuminemia (odds ratio [OR], 2.5; P=0.029), history of chronic obstructive pulmonary disorder or pneumonia (OR, 2.4; P=0.029), and diabetes mellitus (OR, 2.5; P=0.001) were significantly associated with inpatient TEA, as were greater odds of any complication (OR, 4.1; P<0.001) or adverse discharge (OR, 4.5; P<0.001) and decreased odds of reoperation (OR, 0.4; P=0.037). Conclusions: Patients undergoing inpatient TEA are generally more comorbid, and inpatient surgery is associated with greater odds of complications and adverse discharge. However, we found higher rates of reoperation in outpatient TEA. Our findings suggest outpatient TEA is safe, although patients with a higher comorbidity burden may require inpatient surgery. Level of evidence: III.

• Journal of Chest Surgery
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• v.47 no.6
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• pp.563-565
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• 2014

Outpatient drainage therapy is generally indicated for spontaneous pneumothoraces. A 63-year-old man, who had been attacked by a bull sustaining injuries on the right side of his chest, was referred to the emergency room with dyspnea. His chest X-ray showed a small pneumothorax. The next day, a chest X-ray demonstrated that his pneumothorax had worsened, although no hemothorax was identified. Outpatient drainage therapy with a thoracic vent was initiated. The air leak stopped on the third day and the thoracic vent was removed on the sixth day. Thoracic vents can be a useful modality for treating traumatic pneumothorax without hemothorax.

• Perspectives in Nursing Science
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• v.13 no.1
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• pp.48-57
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• 2016

Purpose: The purpose of this study was to investigate the research methods, contents, and effects of providing information to alleviate patients' anxiety during outpatient surgery. Methods: The PICOTS-SD (Participants, Interventions, Comparisons, Outcomes, Time, Setting, Study design) was used and 11 randomized controlled trials studies that met the inclusion and exclusion criteria were selected. For assessing the quality of the studies, the Cochrane Risk of Bias tool was used. Results: In the 11 selected studies, intervention methods included verbal, written paper, video, and websites, and the outcome variable was anxiety. Regarding the effectiveness of providing information on anxiety, the result of the present study was ambivalent. Conclusion: This study showed the current trends in providing information as an intervention. However, randomized controlled trials are further needed in Korea, to verify the effects of such an intervention on patients' anxiety.

• Health Policy and Management
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• v.24 no.3
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• pp.254-260
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• 2014

Background: The purpose of this study is to assume appropriate outpatient consultation time for each clinical department on the basis of measured outpatient consultation time and satisfaction of outpatient. Methods: We surveyed the feeling and satisfactory outpatient consultation time, satisfaction, revisiting intention and recommendation to others to 1,105 patients of single general hospital in Gyeonggi-do and measured their real outpatient consultation time from October 28 to November 27 in 2013. On the basis of satisfaction, we estimated appropriate outpatient consultation time through area under the receiver operating characteristic curve in logistic regression model. Results: Feeling outpatient consultation time was 5.1 minutess, satisfactory outpatient consultation time which was suggested by patient was 6.3 minutes, and real outpatient consultation time was 4.2 minutes. Department which had longest real outpatient consultation time was infection (7 minutes) and department which had longest satisfactory outpatient consultation time was neurology (9.4 minutes). From the univariate and the multiple linear regression analysis, real outpatient consultation time was longer in pulmonology patient, new patient and afternoon patient, satisfactory outpatient consultation time was longer in infection, neurology, neuropsychiatry, neurosurgery, and rehabilitation patient. Appropriate real outpatient consultation time was suggested as 5.6 minutes which differentiated high and low satisfied patient group. However, we could not assume appropriate outpatient consultation time for each clinical department because the number of patient who had bad satisfaction was too low. Conclusion: To improve patient's satisfaction, we hope outpatient reservation system is operated as each patient's outpatient consultation time is at least 5.6 minutes.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.61-68
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• 2022

Background: While the coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of health care, its impact on cardiac surgical practice and outcomes is yet to be determined. We compared the outcomes of our cardiac surgical practice from the past year during the pandemic to those in a similar pre-pandemic period. Methods: Retrospective data were collected from 307 patients who were involved in all adult cardiac surgical procedures performed between March 2020 and February 2021, which was considered the pandemic period, at Amrita Institute of Medical Sciences, India. These were compared with data from the 1-year period between March 2019 and February 2020. During that earlier period, 491 patients underwent surgery, and the surgical outcomes were assessed. Outpatient visit data were also collected to evaluate the effect of COVID-19 on outpatient follow-up visits. Results: A 37% decrease in surgical case volume was observed during the study period. No difference was found in operative mortality between the 2 time periods (3.3% vs. 2.6%, p=0.383). Overall postoperative complications were less frequent during this period, at 23% compared to 38% the previous year (p<0.001). Conclusion: The COVID-19 pandemic caused a dramatic decrease in surgical volume and outpatient medical follow-up. However, the pandemic and its attendant social restrictions did not yield a significant change in the surgical outcomes of our patients. Hence, it is reasonable to continue cardiac surgical care during global health crises, and this can be done with good results.