OBJECTIVE: To evaluate the burden experienced by primary informal caregivers of patients who have undergone hip arthroscopy and to identify factors that predict increased caregiver burden.
METHODS: A cross-sectional study was conducted at a single academic hospital centre, enroling caregivers of patients who underwent hip arthroscopy between November 2018 and November 2023. Caregiver burden was assessed using the Caregiver Burden Inventory (CBI) survey. Multivariable linear regression models were used to identify predictors of caregiver burden, with the global CBI score serving as the primary outcome measure. Secondarily, open-ended survey questions were analyzed qualitatively to elucidate specific challenges and facilitators of caregiving, as reported by the caregivers themselves.
RESULTS: The study involved 99 eligible caregivers (mean [standard deviation] age; 47 [11] years), 58% were female, and 85% were relatives of the patient. The median global CBI score was 13.0 (interquartile range: 8.0-22.4), indicating a moderate burden. Regression analyses demonstrated that younger caregiver age and a higher number of caregiving tasks were significant predictors of increased global burden. Additionally, nonweightbearing status of patients, female gender of caregivers and working full-time statistically significantly increased specific dimensions of caregiver burden.
CONCLUSIONS: This study highlights the meaningful burden faced by caregivers of patients undergoing hip arthroscopy, despite its minimally invasive nature and outpatient setting. Identified risk factors such as younger caregiver age, female gender of the caregiver, nonweight-bearing status and increased caregiving tasks suggest targeted areas for intervention. The qualitative analysis revealed that caregivers struggle with time management and physical and emotional strain, yet better communication and practical support from healthcare teams could help to alleviate these challenges.
METHODS: Level IV, prognostic study.

OBJECTIVE: Outpatient surgery and same-day discharge are developing fields that align with the evolving needs of modern healthcare, presenting a notable advantage by reducing patient susceptibility to nosocomial infections, thromboembolic complications, and medical errors. When paired with enhanced recovery after surgery protocols, they hold promise in safely transitioning certain patients undergoing cranial surgery to outpatient care. This study aimed to evaluate discharge on the same day of surgery after intracranial tumor resection and endoscopic third ventriculostomy (ETV) and to investigate potential associations with anesthesia methods, complications, and readmission rates.
METHODS: A retrospective analysis of patients scheduled for planned discharge on the same day of surgery between August 2020 and October 2023 was conducted. Data included patient demographic characteristics, preoperative clinical deficits, diagnosis, findings on preoperative and postoperative MRI, lesion characteristics, complications, and readmission rates.
RESULTS: A total of 202 patients were included in the study. The mean age was 56.8 years and 117 (57.9%) patients were female. Patients were admitted the evening before surgery to obtain preoperative clearance and undergo MRI. The most common diagnoses were metastasis (23.3%), meningioma (20.8%), glioblastoma (12.4%), and low-grade glioma (10.4%). Craniotomy (46.5%), stereotactic needle biopsy (35.1), and ETV (6.9%) were the most common procedures performed. Thirteen (6.4%) patients underwent awake craniotomy, and 189 (93.6%) surgical procedures were conducted under general anesthesia. Complications occurred in 1.5% of patients, with no permanent complications observed during a mean follow-up of 9.3 months. In total, 179 (88.6%) patients were successfully discharged on the same day of surgery. The median length of hospitalization was 26.8 hours, with the median length of postoperative stay being 7 hours. Twenty-three (11.4%) patients were deemed ineligible for discharge on postoperative day 0 and instead discharged on postoperative day 1. The reasons for these delays included further clinical monitoring (n = 12), social factors (n = 4), and patient preference (n = 7). Age was positively correlated with length of hospitalization (p = 0.006). In total, 6.4% of patients were readmitted within 1-30 days after discharge, with 2.5% readmitted to the department of neurosurgery.
CONCLUSIONS: This study demonstrates the safety and feasibility of discharge on the same day of surgery, with a high success rate and low complication rates. Early discharge did not increase morbidity or readmission rates. Implementation of clear discharge protocols and thorough patient education are crucial for successful same-day discharge programs in neurosurgery.

UNASSIGNED: Lumbar disc herniation (LDH) is a common condition that can be characterized with disabling pain. While most patients recover without surgery, some still require operative intervention. The epidemiology and trends of laminotomy for LDH have not been recently studied, and current practice patterns might be different from historical norms. This study aimed to investigate the trends of inpatient and outpatient laminotomies for LDH and compare complication rates between these two sites of service.
UNASSIGNED: A large, national database was utilized to identify patients > 8 years old who underwent a laminotomy for LDH between 2009 and 2019. Two cohorts were created based on site of surgery: inpatient versus outpatient. The outpatient cohort was defined as patients who had a length of stay less than 1 day without any associated hospitalization. Epidemiologic analyses for these cohorts were performed by demographics. Patients in both groups were then 1:1 propensity-score matched based on age, sex, insurance type, geographic region, and comorbidities. Ninety-day postoperative complications were compared between cohorts utilizing multivariate logistic regressions.
UNASSIGNED: The average incidence of laminotomy for LDH was 13.0 per 10,000 persons-years. Although the national trend in incidence had not changed from 2009 to 2019, the proportion of outpatient laminotomies significantly increased in this time period (p=.02). Outpatient laminotomies were more common among younger and healthier patients. Patients with inpatient laminotomies had significantly higher rates of surgical site infections (odds ratio [OR] 1.61, p<.001), venous thromboembolism (VTE) (OR 1.96, p<.001), hematoma (OR 1.71, p<.001), urinary tract infections (OR 1.41, p<.001), and acute kidney injuries (OR 1.75, p=.001), even when controlling for selected confounders.
UNASSIGNED: Our study demonstrated an increasing trend in the performance of laminotomy for LDH toward the outpatient setting. Even when controlling for certain confounders, patients requiring inpatient procedures had higher rates of postoperative complications. This study highlights the importance of carefully evaluating the advantages and disadvantages of performing these procedures in an outpatient versus inpatient setting.

OBJECTIVE: To evaluate patients\' satisfaction with opioid versus opioid-sparing postoperative analgesia in patients undergoing outpatient head and neck surgery.
METHODS: Prospective randomized trial.
METHODS: Tertiary care academic hospital.
METHODS: Adult patients undergoing outpatient head and neck surgery were randomly assigned to 1 of 3 analgesic regimens. First- and second-line medications were the following by group (1) Hydrocodone-acetaminophen with ibuprofen, (2) ibuprofen with hydrocodone-acetaminophen, and (3) ibuprofen with acetaminophen. Preoperative counseling was provided to patients regarding expected pain and proper medication use. Postoperative questionnaires were administered to assess satisfaction.
RESULTS: One hundred three patients were enrolled in the study (mean age, 56.5 years; women, 75 [73%]). The mean satisfaction score with the pain regimen assigned was similar between the 3 groups (scale 0-10, [7.7, 8.3, 8.5, P = .46]). A similar percentage of patients in each group reported that surgery was more painful than anticipated (25%, 32%, 26%, P = .978), and a similar percentage of patients reported willingness to utilize the same analgesic regimen following future surgeries (75%, 83%, 76%, P = .682). Additional questions evaluating the side effect profile, maximum and minimum pain scores, and difficulty of recovery were not statistically different between the 3 groups.
CONCLUSIONS: In the postoperative population for outpatient head and neck surgeries, there was no significant difference in patient satisfaction and pain control between the opioid and nonopioid arms. Providers should discuss opioid-sparing regimens preoperatively with patients and describe them as effective in providing adequate pain control without a significant impact on patient\'s perception of care.

OBJECTIVE: Postoperative nausea and vomiting (PONV) is a common sequela of surgery in patients undergoing general anesthesia. Amisulpride has shown promise in its ability to treat PONV. The objective of this study was to determine if amisulpride is associated with significant changes in PACU efficiency within a fast-paced ambulatory surgery center.
METHODS: This was a retrospective cohort study of 816 patients at a single ambulatory surgery center who experienced PONV between 2018 and 2023. The two cohorts analyzed were patients who did or did not have amisulpride among their anti-emetic regimens in the PACU during two distinct time periods (before and after amisulpride was introduced). The primary outcome of the study was PACU length of stay. Both unmatched analysis and a linear multivariable mixed-effects model fit by restricted maximum likelihood (random effect being surgical procedure) were used to analyze the association between amisulpride and PACU length of stay. We performed segmented regression to account for cohorts occurring during two time periods.
RESULTS: Unmatched univariate analysis revealed no significant difference in PACU length of stay (minutes) between the amisulpride and no amisulpride cohorts (115 min vs 119 min, respectively; P = 0.07). However, when addressing confounders by means of the mixed-effects multivariable segmented regression, the amisulpride cohort was associated with a statistically significant reduction in PACU length of stay by 26.1 min (P < 0.001).
CONCLUSIONS: This study demonstrated that amisulpride was associated with a significant decrease in PACU length of stay among patients with PONV in a single outpatient surgery center. The downstream cost-savings and operational efficiency gained from this drug\'s implementation may serve as a useful lens through which this drug\'s widespread implementation may further be rationalized.

BACKGROUND: Even now the further training in surgery faces considerable challenges. The planned hospital structural reform will result in new bureaucratic and organizational hurdles, which could lead to a considerable loss of quality in advanced surgical training across all disciplines.
OBJECTIVE: The aim of this position paper is to describe the current and future challenges for advanced surgical training and to identify possible approaches and opportunities for the further development against the background of the planned hospital structural reform.
METHODS: For the development of this position paper a committee of representatives of the Young Forums of the German surgical societies identified and critically discussed current problems and challenges of the present residency training system and formulated a list of demands for a sustainable residency training concept.
RESULTS: The planned shift to outpatient treatment and centralization were identified as central challenges for surgical residency training. Surgical training must be considered consistently and from the outset in all political reform efforts. In addition to a transparent and cost-appropriate financing of residency training, we call for the involvement of all German surgical societies in the reform process. Furthermore, the social framework conditions for junior surgeons should be considered.
CONCLUSIONS: The structural change in the hospital landscape in Germany, which is being forced by politicians, harbors the risk of a further loss of quality and experience in surgical treatment and training. At the same time, the planned hospital reform offers a unique opportunity to address existing problems and challenges in surgical training and to consider them as a starting point for structural changes which are fit for the future.
UNASSIGNED: HINTERGRUND: Die chirurgische Weiterbildung steht bereits jetzt vor erheblichen Herausforderungen. Durch die geplante Krankenhausstrukturreform kommen neue bürokratische und organisatorische Hürden hinzu, die zu einem erheblichen Qualitätsverlust der chirurgischen Weiterbildung führen können.
UNASSIGNED: Das vorliegende Positionspapier beschreibt aktuelle und zukünftige Herausforderungen für die chirurgische Weiterbildung und identifiziert mögliche Ansatzpunkte und Chancen für ihre Weiterentwicklung vor dem Hintergrund der geplanten Krankenhausstrukturreform.
METHODS: Für die Erarbeitung dieses Positionspapiers wurden durch ein Gremium aus Vertreterinnen und Vertreter der Jungen Foren der Deutschen Fachgesellschaften der chirurgischen Fächer aktuelle Probleme und Herausforderungen des derzeitigen Weiterbildungssystems identifiziert, kritisch diskutiert und ein Forderungskatalog für ein zukunftsfähiges Weiterbildungskonzept formuliert.
UNASSIGNED: Die geplante Ambulantisierung und Zentralisierung wurden als zentrale Herausforderungen für die chirurgische Weiterbildung identifiziert. Die ärztliche Weiterbildung muss bei allen Reformbestrebungen konsequent und von Anfang an mitgedacht werden. Neben einer transparenten und aufwandsgerechten Finanzierung der Weiterbildung fordern wir die Einbeziehung der Fachgesellschaften sowie eine Beachtung der sozialen Rahmenbedingungen für den chirurgischen Nachwuchs.
UNASSIGNED: Der von der Politik forcierte Strukturwandel der Krankenhauslandschaft in Deutschland birgt die Gefahr, dass es zu einem weiteren Qualitäts- und Erfahrungsverlust in der chirurgischen Versorgung und Weiterbildung kommt. Gleichzeitig bietet das geplante Reformvorhaben aber die einzigartige Chance, bestehende Probleme aufzugreifen und die chirurgische Weiterbildung zukunftsfähig weiterzuentwickeln.

暂无摘要。

Introduction The prevalence of one-day surgery (also known as same-day surgery or outpatient surgery) has been increasing recently among patients and physicians in many countries due to its benefits. The main benefits of one-day surgery are that the patient is not planned to stay overnight before the surgery and can be discharged on the same day of the surgery. The lower cost to the health system can make these surgeries more favorable for both sides. However, unplanned readmission after such surgeries can happen and this has broad implications for patients, their families, and the healthcare system. Therefore, this study primarily aims to identify the incidence of unexpected hospital readmissions following one-day surgery after discharge among children. The study also aims to identify any significant variables that can be identified with the cases of readmissions to allow for further investigations in future studies Methods This study was done at King Abdullah Specialist Children\'s Hospital in Riyadh, Saudi Arabia. The target population included all pediatric patients who underwent one-day surgeries and were admitted within one week of their discharge from 2017 to 2023 through outpatient clinics and the emergency department. Results The study sample size was 403 patients, with male patients accounting for 241 surgeries (59.8%), and female patients accounting for 162 surgeries (40.1%). The most common American Society of Anesthesiologists (ASA) classification was II, accounting for 169 cases (41.9%). Toddlers and preschoolers (aged 1-6 years) were the age groups with the highest number of patients (n=252, 62.5% combined). Elective surgeries accounted for 382 cases (94.7%). The specialty with the highest number of surgeries was ear, nose, and throat with 284 cases (70.4%) with tonsillectomy with adenoidectomy being the most common surgery with 234 cases (58%). The most common reasons for unplanned readmission were poor oral intake (n=146, 36.2%) and bleeding (n=131, 32.5%). The most common day of readmission was the seventh day in five surgical specialties (45.4%). Conclusion Over the past seven years, 403 patients were readmitted within one week after their one-day surgery at King Abdullah Specialist Children\'s Hospital. Such a situation may cause dissatisfaction with the medical care that the patients were given and eventually may build an untrusted relationship between the patient and the physician. Future investigations should be established to lower such a condition and develop prevention methods to lower its prevalence.

BACKGROUND: Understanding the average time from surgery to discharge is important to successfully and strategically schedule cases planned for same day discharge (SDD) for total knee arthroplasty (TKA). The purpose of this study was to (1) evaluate the average time to discharge following unilateral TKA performed in a community hospital and (2) describe patient characteristics and peri-operative factors that may impact SDD.
METHODS: This retrospective review included 75 patients having achieved SDD following unilateral TKA between March 2017 and September 2021 at a high-volume multi-specialty community hospital. Time to discharge was calculated from end of surgery, defined as completion of dressing application, to physical discharge from the hospital. Time surgery completed and association with time of discharge was also examined. Pearson\'s correlations were performed to evaluate the relationship between total time to discharge and patient demographics.
RESULTS: The average age for all patients was 66.6 ± 10.9 years (Range: 38 to 86) and average BMI of 29.9 ± 5.6 kg/m2 (Range: 20.4 to 46.3). The average time to discharge was 5.8 ± 1.8 h (range: 2.2 to 10.5 h). Time to discharge was significantly longer for patients finishing surgery prior to noon (6.0 ± 1.8 h), than after noon (4.8 ± 1.4 h, p = 0.046). Total time to discharge was not correlated with age (r = 0.018, p = 0.881) or BMI (r=-0.158, p = 0.178), but was negatively correlated with surgical start time (r=-0.196, p = 0.094).
CONCLUSIONS: An average of six hours was required to achieve SDD following unilateral TKA performed in a community hospital. The time required for SDD was not found to be related to intrinsic patient factors but more likely due to extrinsic factors associated with time of scheduled surgery. To improve success of SDD, focus should be placed on the development of efficient discharge pathways rather than unchangeable intrinsic patient characteristics.

OBJECTIVE: The use of outpatient surgery in inguinal hernia is heterogeneous despite clinical recommendations. This study aimed to analyze the utilization trend of outpatient surgery for bilateral inguinal hernia repair (BHIR) in Spain and identify the factors associated with outpatient surgery choice and unplanned overnight admission.
METHODS: A retrospective observational study of patients undergoing BIHR from 2016 to 2021 was conducted. The clinical-administrative database of the Spanish Ministry of Health RAE-CMBD was used. Patient characteristics undergoing outpatient and inpatient surgery were compared. A multivariable logistic regression analysis was performed to identify factors associated with outpatient surgery choice and unplanned overnight admission.
RESULTS: A total of 30,940 RHIBs were performed; 63% were inpatient surgery, and 37% were outpatient surgery. The rate of outpatient surgery increased from 30% in 2016 to 41% in 2021 (p < 0.001). Higher rates of outpatient surgery were observed across hospitals with a higher number of cases per year (p < 0.001). Factors associated with outpatient surgery choice were: age under 65 years (OR: 2.01, 95% CI: 1.92-2.11), hospital volume (OR: 1.59, 95% CI: 1.47-1.72), primary hernia (OR: 1.89, 95% CI: 1.71-2.08), and laparoscopic surgery (OR: 1.47, 95% CI: 1.39-1.56). Comorbidities were negatively associated with outpatient surgery. Open surgery was associated (OR: 1.26, 95% CI: 1.09-1.47) with unplanned overnight admission.
CONCLUSIONS: Outpatient surgery for BHIR has increased in recent years but is still low. Older age and comorbidities were associated with lower rates of outpatient surgery. However, the laparoscopic repair was associated with increased outpatient surgery and lower unplanned overnight admission.