Grisel’s syndrome is a rare cervical spine disorder characterized by non-traumatic rotary subluxation of the atlantoaxial joint. This article provides a systematic review to collect evidence on its pathogenesis, clinical manifestations, diagnosis, treatment, complications, and risk management, in order to guide clinical diagnosis and treatment. The syndrome is often associated with adenotonsillectomy. Patients typically present with neck stiffness, pain, and a “cock robin posture” (chin tucked in and head tilted forward). Diagnosis relies on MRI and CT scans. After timely diagnosis, most patients can control the condition through conservative treatment. However, those with ineffective conservative treatment or severe subluxation may require surgical intervention. Therefore, early diagnosis and treatment are crucial. This article focuses on the progress in the diagnosis and treatment of Grisel’s syndrome after adenotonsillectomy, which will provide new insights into the diagnosis and treatment of this rare disease.
The concept of enhanced recovery after surgery (ERAS) is composed of multidisciplinary, multimodal, and evidence-based approaches, providing a safe and cost-effective method for perioperative management to improve patient prognosis without increasing the incidence of complications. At present, ERAS for cardiac surgery has developed slowly. This article provides a review of the application and prospects of ERAS concept in the perioperative period of cardiac surgery. The measures for applying ERAS concept to the perioperative period of cardiac surgery are divided into three parts: preoperative, intraoperative, and postoperative. The aim is to provide information for the perioperative management of cardiac surgery patients and assist in their rapid recovery during the perioperative period.
With the rapid development of day surgery in China, ensuring continuous recovery services for patients after discharge has become an urgent issue. In response, this paper outlines the concept and development status of day surgery, emphasizes the importance of establishing an extended recovery system, summarizes relevant model innovation cases, discusses key elements for building an extended recovery system, including social resource engagement, multidisciplinary collaboration, institutional safeguards and technical support, and docking system platform to smooth the transmission of information, and proposes suggestions for future development. This paper provides theoretical and practical references for developing an extended recovery system for day surgery in China.
In order to optimize the postoperative rehabilitation path of patients undergoing fourth-level day surgery, West China Hospital of Sichuan University has learned from the abroad “recovery hotel” mode and innovatively regarded the primary rehabilitation institution as an extended service carrier for thoracoscopic lung nodule day surgery. This extended rehabilitation mode based on primary rehabilitation institutions is not only beneficial for shortening the hospitalization period and reducing medical costs, but also ensures medical safety through a standardized postoperative monitoring system, providing innovative solutions for the full process management of day surgeries. This article will introduce the specific implementation methods and preliminary practical results of the extended rehabilitation mode mentioned above.
Objective To investigate the risk factors for delayed discharge following same-day choledochoscopic lithotomy for residual stones after biliary tract surgery. Methods The clinical data of 607 patients with residual stone after biliary tract surgery admitted to the Day Surgery Center of West China Hospital of Sichuan University between July 2019 and July 2022 were retrospectively collected. According to whether the patients were discharged on the same day, they were divided into same-day discharge group and delayed discharge group. The differences in gender, age, first surgical procedure (surgical method, hepatectomy or not, intraoperative choledochoscopy or not), choledochoscopic lithotomy (first choledochoscopy or not, lithotomy method, number of stones and site of stones), operation duration, hospital stay, hospital cost, and postoperative complications (fever, poor drainage, and T tube dislodgement) between the two groups were compared and analyzed. Multiple logistic regression model was used to analyze the risk factors for delayed discharge following same-day choledochoscopic lithotomy. Results All patients were admitted and discharged within 24 h, among them, 557 cases (91.8%) were discharged on the same day and 50 cases (8.2%) were discharged the next day. The results of multiple logistic regression analysis showed that choledochoscopy for the first time [odds ratio (OR)=2.359, 95% confidence interval (CI) (1.303, 4.273), P=0.005], lithotomy after electrohydraulic lithotripsy [OR=1.857, 95%CI (1.013, 3.402), P=0.045], and multiple stones (number of stones ≥2) [OR=2.741, 95%CI (1.194, 6.288), P=0.017] were independent risk factors for delayed discharge. Conclusion The operation of same-day choledochoscopic lithotomy is mature, and choledochoscopy for the first time, lithotomy after electrohydraulic lithotripsy, and multiple stones (number of stones ≥2) are independent risk factors for delayed discharge.
The strategies of individualized enhanced recovery after surgery (ERAS) are particularly important in the anesthesia management of same-day surgery. This review focuses on the perioperative management of day surgeries following the experiences of Day Surgery Center, West China Hospital, Sichuan University and different surgeries’ guidelines of ERAS, including anesthesia evaluation, preoperative education and optimization, comorbidity management, airway management, choice of technologies and drugs during anesthesia, intraoperative monitor and anesthesia management, postoperative analgesia, postoperative nausea and vomiting prevention, and postoperative management, which is significant to ensure the discharge of the patient in time for same-day surgeries.