随着择期手术服务从COVID-19大流行中恢复,向日间手术的转变可能会减少等待名单。然而,需要证据证明日间手术对于内窥镜鼻窦手术(ESS)是安全的.这项研究的目的是调查英格兰日常ESS的安全性。
管理数据的二次分析。
我们从医院事件统计数据库中提取了2014年4月1日至2019年3月31日5年的数据。纳入年龄≥17岁的接受选择性ESS手术的患者。排除标准包括恶性肿瘤,复杂的全身性疾病和经蝶窦垂体手术。主要结果是出院后30天内再次入院。多层次,多变量逻辑回归模型用于比较以日间病例进行手术的患者和在调整人口统计后过夜的患者的结果。脆弱,合并症和程序协变量。
数据可用于在129个NHS医院信托中进行手术的49223名患者。在研究期间,信托基金对50多名患者进行了手术,日间手术率从20.6%到100%不等。在全国范围内,日间手术率从2014/2015财政年度的64.0%上升至2018/2019财政年度的78.7%。日间病例患者的30天急诊再入院率较低(比值比0.71,95%置信区间0.62至0.81)。与接受信托手术且日间手术率<50%的患者相比,接受信托手术的患者的结果相似。
我们的数据支持以下观点:在大多数情况下,ESS可以安全地作为日常手术进行,虽然它不适合所有患者。在英格兰的一些医院信托基金中,似乎有可能提高日间病例ESS的发生率。
As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for endoscopic sinus surgery (ESS). The aim of this study was to investigate the safety of day-case ESS in England.
Secondary analysis of administrative data.
We extracted data from the Hospital Episodes Statistics database for the 5 years from 1 April 2014 to 31 March 2019. Patients undergoing elective ESS procedures aged ≥17 years were included. Exclusion criteria included malignant neoplasm, complex systemic disease and trans-sphenoidal pituitary surgery. The primary outcome was readmission within 30 days post-discharge. Multilevel, multivariable logistic regression modelling was used to compare outcomes for those operated on as day-cases and those with an overnight stay after adjusting for demographic, frailty, comorbidity and procedural covariates.
Data were available for 49 223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day-case surgery varied from 20.6% to 100%. Nationally, rates of day-case surgery increased from 64.0% in the financial year 2014/2015 to 78.7% in 2018/2019. Day-case patients had lower rates of 30-day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). Outcomes for patients operated on in trusts with ≥80% day-case rates compared with patients operated on in trusts with <50% rates of day-case surgery were similar.
Our data support the view that ESS can safely be performed as day-case surgery in most cases, although it will not be suitable for all patients. There appears to be scope to increase rates of day-case ESS in some hospital trusts in England.