PubMed · 15283374
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Roger Taylor. 2004-07-01. Day-case surgery.. https://pubmed.ncbi.nlm.nih.gov/15283374/
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BACKGROUND: Global budgeting was partially replaced by activity-based funding in 1999 in order to improve productivity and reduce waiting lists. The aim of this study is to estimate otolaryngologic surgery rates after the introduction of Diagnosis Related Groups funding. MATERIAL AND METHOD: National data on outpatient and inpatient otolaryngologic surgical procedures over the period 1999 to 2002 were provided by the Norwegian Patient Register; an estimate was made of the proportion undergoing uvuloplasty for sleep apnea or snoring. RESULTS: From 1999 to 2002, there was an overall increase in otolaryngologic procedures of 12%. Inter-procedural variation ranged from a 110% increase in uvuloplasties to a 12 % decrease in tonsillectomies. There was a particular increase in procedures requiring neither general anaesthesia nor a highly specialised surgeon. In spite of the increased rates of uvuloplasty, the proportion of patients selected for surgery remained unchanged. INTERPRETATION: The substantial increase in certain procedures may give rise to several interpretations: better medical technology, reallocation of surgical resources to disorders that had been inadequately covered, or a shift towards procedures for which marginal costs do not exceed treatment costs.
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The goal of this study was to assess which factors affect length of stay in patients operated on for a thyroglossal duct cyst (TDC) and whether day surgery is a safe alternative to a postoperative admission. All charts of patients with TDC excisions at one children's hospital from 1995 to 2001 were reviewed retrospectively. Chi-square tests and multiple logistic regression were used as statistical tests, with p<0.05 considered significant. One hundred children with a mean age of 6 years were operated on for TDC; 46% had day-surgery, with a median length of stay (LOS) of 4 h, and the other 54% were admitted overnight after TDC excision, with a median LOS of 24 h. Factors that significantly prolonged LOS were drain placement, start of surgery after 1 p.m., and surgery being performed by the ENT surgical service rather than the pediatric general surgery service. There was only one hospital readmission for a patient with day surgery at 36 h postoperation for wound hematoma that resolved with nonoperative treatment. Day surgery is safe for routine TDC excisions. There must be a shift in surgeons' behavior if the trend towards an increase in outpatient services for TDC excisions is to continue.