PubMed · 10317002
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T R O'Donovan. 1980. Ambulatory surgery update: pros and cons of basic program models.. https://pubmed.ncbi.nlm.nih.gov/10317002/
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We describe the development of a pediatric outpatient transplant program and our initial experience with autologous and allogeneic transplants performed partially or completely in the outpatient setting. Forty-eight autologous and seven allogeneic transplants have been performed in our institution in the outpatient setting between June 1994 and July 2000. The ablation used for the autologous outpatient transplants was VP-16 1000 mg/m2/ day as a continuous infusion for 2 days and Carboplatinum 667mg/m2/day for 2 days. The autologous inpatient transplants received Thio-tepa 300-mg/ m2per day x 3 days and cyclophosphamide 60 mg/kg/day for 4 days. For those patients who received an immune-ablative allogeneic outpatient transplant, the regimen consisted of Fludarabine 30 mg/m2/day for 6 days, followed by busulfan for children less than five years of age 1 mg/kg/dose x 8 doses and for those five years and older 0.8 mg/kg/dose x 8 doses, followed by ATG 40mg/kg/day x 4 days. Engraftment was complete in all transplants achieving an ANC >500 for the outpatient transplant in 15 days (10-35) vs. the inpatient in 15 days (14-58). This was not statistically significant. They achieved un-sustained platelets >20.0 by day 19 (14-58) for the outpatients and day 32 10-64) for the inpatient. The allogeneic immune ablative transplants were considered engrafted when their VNTRs were greater that 30% which was achieved at a median of 13 days (10-27). The economic data showed a statistically significant decrease in charges and direct costs between the outpatient (median charges $30 775, direct costs $8 389) and the inpatient (median charges $99 838, direct costs $42 757) transplants (p0.001). There was no difference in morbidity and mortality between the two groups but the use of empiric amphotericin B was markedly decreased in the outpatient transplants. In conclusion it is feasible and less costly to perform autologous hematopoietic stem cell transplants in the outpatient setting with no increase in morbidity and mortality. For the allogeneic transplants there is not yet enough data to establish a similar conclusion.
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INTRODUCTION: The present study was undertaken to investigate the safety of mediastinoscopy as a routine outpatient procedure. METHODS: We reviewed the first 108 mediastinoscopies performed at our outpatient surgery centre. RESULTS: During the period, 1996 to 1999, 108 out of 206 (52%) mediastinoscopy patients were admitted to the outpatient surgery centre, and 86 (80%) of these were discharged the same day. These numbers were 86% and 86% for 1999 alone, which reflects acceptance of outpatient surgery. One patient was admitted because of preoperative mediastinal venous bleeding, which required compression for 24 hours, and 19 more patients were admitted without strict medical indications. Two patients were admitted later the same day after discharge, because of minor wound bleeding, which was stopped by infiltration with adrenalin. DISCUSSION: Mediastinoscopy can be performed safely as an outpatient procedure on most patients.