PubMed · 14213695
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D HEGINBOTHAM, H B RAINEY. 1964. DAY SURGERY.. https://pubmed.ncbi.nlm.nih.gov/14213695/
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The authors present a study of 775 patients who underwent a Shouldice herniorrhaphy between 1987 and 2000, as performed by one surgeon. Average patient age was 52 years, and 93% of patients were male. Local anesthesia with sedation was used in 643 cases (83%) and regional anesthesia in 13%. The length of the incision was 9.5 cm. The average duration of surgery was 57.5 min (40-75). Tolerance to local anesthesia with sedation was 93%, a similar percentage to that of general anesthesia. The most significant postoperative complications were: urinary retention 8%, headache 7%, and ecchymosis 6%. Hospitalization time in 76% of the cases was 1 day, while 20% of interventions were undertaken on an outpatient basis. The average absence from work was 20 days. The recurrence rate at 7 years was 2%.
INTRODUCTION: Despite the priority placed on it, minor surgery is not performed enough in primary care (PC). OBJECTIVE: To create and evaluate a programme to introduce and develop minor out-patient surgery in primary care in a way that matches our health areas needs. DESIGN: Prospective, longitudinal and descriptive study. SETTING: Health Area 19 (Valencian Health Service): Surgery Department of Elche Hospital and 3 health centres (HC) (Altabix, Crevillente and Santa Pola). PARTICIPANTS: PC doctors and specialist surgeons. STAGES: a) Selection of HC. Working out protocol of kind of patient, pathology, paper-work and establishment of work circuits; b) surgical sessions at the HC, performed by two surgeons assisted by PC doctors (surgical leaders) and with surgical instruments from the hospital; c) surgery performed by PC doctors supervised by a surgeon, with instruments and the sterilisation circuit in the HC. The programme ends up with the PC doctors surgical autonomy and with use of the HCs own resources. RESULTS: 41 surgical sessions took place (14 in Altabix, 14 in Crevillente and 13 in Santa Pola). 335 patients were operated on in 398 surgical procedures (55.5% excisions, 34.9% electrocoagulation, 9.6% others). There were no immediate complications. The monthly evolution in the number of patients was constant, with a mean of 10.22 interventions per session. 36 doctors referred patients and 24 of them performed a surgical procedure. CONCLUSIONS: A practical and safe programme to introduce and develop minor surgery in PC, to the satisfaction of doctors and patients.
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