PubMed · 10289101
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K M Mittal, S K Jamdagneya, Y K Singh. Methodology for estimating bed requirements.. https://pubmed.ncbi.nlm.nih.gov/10289101/
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BACKGROUND: Women undergoing surgery for primary breast cancer routinely have suction drains inserted deep to the wounds, which are removed approximately 6-8 days after operation, requiring a period of stay of that duration in hospital. The aim of this study was to perform a prospective randomized clinical trial to evaluate a new surgical technique of suturing flaps without wound drainage, combined with early discharge, in women undergoing surgery for breast cancer. METHODS: A total of 375 patients undergoing surgery for breast cancer were randomized to conventional surgery or suturing of flaps with no drain. The main outcome measures were length of hospital stay, surgical morbidity, psychological morbidity and health economics. RESULTS: Suturing of flaps and avoiding wound drainage in women undergoing surgery for breast cancer resulted in a significantly shorter hospital stay. Adopting this surgical technique with early discharge did not lead to any difference in surgical or psychological morbidity. Health economic benefits to the National Health Service resulted from saved bed days with no impact on community costs. CONCLUSION: Wound drainage following surgery for breast cancer can be avoided, thereby facilitating early discharge with no associated increase in surgical or psychological morbidity.
OBJECTIVES: This report describes the extent of deregionalization of neonatal intensive care in urban areas of the United States in the 1980s and 1990s and the factors associated with it. METHODS: We conducted a 15-year retrospective analysis of secondary data from US metropolitan statistical areas. Primary outcome measures are number of neonatal intensive care unit (NICU) beds, number of NICU hospitals, and number of small NICUs. RESULTS: Growth in the supply of NICU care has outpaced the need. During the study period (1980-1995), the number of hospitals grew by 99%, the number of NICU beds by 138%, and the number of neonatologists by 268%. In contrast, the growth in needed bed days was only 84%. Of greater concern, the number of beds in small NICU facilities continues to grow. Local regulatory and practice characteristics are important in explaining this growth. CONCLUSIONS: Local policymakers should examine the factors that facilitate the proliferation of services, especially the development of small NICUs. Policies that encourage cooperative efforts by hospitals should be developed. Eliminating small NICUs would not restrict the NICU bed supply in most metropolitan statistical areas.
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