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At least 19 recordsLinked to original sources
PubMed1999

Adenotonsillectomy in the very young patient: cost analysis of two methods of postoperative care.

Postoperative management of the patient younger than 36 months undergoing adenotonsillectomy has been the subject of many debates. Concerns for early postoperative complications such as airway obstruction, emesis, dehydration, and hemorrhage have led many physicians to consider overnight hospitalization following adenotonsillectomy in very young children. Trends in health care management have had increasing focus on cost effective means of treating patients to limit unnecessary expenditure on the part of the patient, physician, and hospital facility. The purpose of this retrospective review was to analyze two methods of early postoperative management in children less than 36 months old undergoing adenotonsillectomy at the Children's Hospital, San Diego from 1992 to 1997. Three hundred and seven cases were reviewed. Same-day discharge was compared with overnight inpatient observation based on the cost analysis of these two methods of postoperative care. Postoperative care was based on length of stay in the recovery room and as an inpatient. Expense of postoperative care was based on cost calculation for the recovery room and overnight hospitalization. Of the 307 patients, 194 went home the day of surgery and 113 were observed overnight in the hospital. Average hospital cost was higher in the outpatient group than in the inpatient group (P < 0.001). This difference reflects longer recovery room stay (350 min) in the outpatient group compared to the inpatient group (108 min) (P < 0.001). Outpatient adenotonsillectomy in the patient under 36 months may be safe; however, prolonged recovery room stays may actually make outpatient surgery less cost-effective than overnight admission. Recovery room costs are significantly higher per unit time than costs of inpatient hospitalization. Further investigation of cost-effective outpatient observation units may improve cost containment in the outpatient surgical setting.

Adenoidectomy↗
PubMed1984

[Progress in postoperative care and postoperative combined therapy of esophageal carcinoma by total parenteral nutrition (TPN)].

Intravenous hyperalimentation which consisted of 30% hypertonic glucose solution and 10% amino acid solution via central venous catheterization and 10% lipid solution via peripheral venous lines has been applied to the postoperative patients with esophageal cancers since 10 years ago. sixty-five percent of the patients who underwent surgical treatment showed abnormal signs of the glucose tolerance function test. Positive application of insulin for these patients was performed according to the algorism of continuous insulin infusion method devised by us. Serum glucose levels have been kept within the normal range during the postoperative days. Non-protein Calorie per nitrogen (Cal/N) was optimal at 190, and 10% of the total Calorie administered should be obtained as lipid solution. Postoperative changes of glucose synthase I and D, and phosphorylase a and b of leukocytes were analysed periodically. Chemiluminescence of leukocytes were also checked. Postoperative combined therapies were actively performed under the nutritional support of TPN. The cases of n (-), n1(+) and n2(+) were treated with radio-chemoimmunotherapy (4000 R, Bleomycin 80 mg, Tegaful 500-750 mg/day, PSK or OK-432). The cases of n3(+) and n4(+) were treated with aggressive chemotherapy (Adriamycin, Mitomycin and Pepleomycin). Remarkable improvement of the prognosis in these patients was obtained.

Animals↗
PubMed2005

Reporting and classification of patient safety events in a cardiothoracic intensive care unit and cardiothoracic postoperative care unit.

OBJECTIVES: The objective was to evaluate a new mechanism for reporting and classifying patient safety events to increase reporting and identify patient safety priorities. METHODS: A voluntary patient safety event reporting system accessible by all health care workers was implemented in the Cardiothoracic Intensive Care and Post Anesthesia Care Units. Information collected included patient identifiers; date, time, and location of report and event; type and description of event; and severity score. Narrative descriptions of events were analyzed and coded to describe when in the care process the event occurred, what occurred, and a causal classification of why the event occurred. RESULTS: A total of 163 reports describing 157 events were received. These included 121 events reported from the intensive care unit (25.3 reported events per 1000 patient-days), a 3-fold increase compared with the preexisting on-line reporting system. A total of 113 reports (69%) came from nurses, 31 from physicians (19%), and 10 from other staff (6%). A majority of events (85, 54%) reached the patient but caused no harm. Multiple causes were identified for the majority of events. The most frequent causes were related to human factors (48%) and organizational factors (34%). CONCLUSIONS: Health care workers were willing to use the patient safety event reporting system, which yielded a broad range of patient safety data. Patient safety events are multifaceted and often have multiple causal factors. Application of a causal classification model for patient safety event coding in the intensive care and preoperative and postoperative care units is feasible and facilitates local communication of important event-related information.

Adult↗
PubMed1996

Pediatric functional endoscopic sinus surgery: postoperative care.

An effective postoperative care regimen is vital for a successful outcome. Children pose special postoperative challenges due to small anatomy, differences in underlying causes of sinus disease, and difficulties encountered with sinonasal cleansing and debridement. This article provides the clinician with a chronologic guide on how to manage the child after functional endoscopic sinus surgery.

Airway Obstruction↗