In recent years, day surgery has developed rapidly in China. It is very important to ensure the medical quality and safety of day surgery patients post-discharge. However, there are no regulations, guidelines or policy on the quality and safety of medical care post-discharge in China yet. As one of the medical institutions which are the earliest to carry out day surgery in a standardized way in China, West China Hospital of Sichuan University has summarized the nearly 10 years’ experiences in day surgery, and formulated management norms after discharge of day surgery, including discharge evaluation, discharge guidance, follow-up after discharge, and emergency plan. This paper introduces the management norms for day surgery post-discharge from West China Hospital ofSichuan University, in order to provide reference for the management of the day surgery patients post-discharge medical care in China.
Day surgery has become an international and domestic medical service model, and it has received more and more attention from hospital administrators in terms of innovation and practical benefits for hospital management. However, from the perspective of standardization management, management norms have still been wanted. This paper introduces the general specification of clinical pathway management for day surgery in West China Hospital of Sichuan University, in order to provide reference for subsequent research, and hopes to provide certain standard models to provide reference for clinical pathway management practice.
ObjectiveTo evaluate the feasibility and safety of laparoscopic cholecystectomy (LC) in same-day surgery model. MethodsThe patients who underwent LC at West China Tianfu Hospital of Sichuan University from November 1, 2023 to July 31, 2024, were retrospectively reviewed. The enrolled patients were divided into a same-day surgery LC group and a conventional inpatient LC group. In the same-day surgery group, a same-day discharge protocol was implemented, whereby patients were admitted, operated on, and discharged on the same day, with discharge required no later than 21:00 without an overnight stay. The conventional inpatient group was managed according to the conventional model. A comparison was carried out between the two groups concerning baseline characteristics, perioperative outcomes, surgery-related complications, postoperative urinary retention, total length of stay, hospitalization costs, and 30-day follow-up results. ResultsA total of 347 patients were included, comprising 164 in the same-day surgery LC group and 183 in the conventional inpatient LC group. No statistically significant differences (P > 0.05) were found between the two groups in the following terms: total anesthesia time, operative time, intraoperative blood loss, intraoperative fluid infusion, length of stay in the post-anesthesia care unit (PACU), fluid infusion in the PACU, placement of abdominal drains, visual analog scale pain score at discharge, rates of unplanned revisits due to changes in their disease conditionwithin 30 d after discharge, readmission rates, and the incidence of surgery-related complications. All complications in both groups were graded as Clavien-Dindo Ⅰ. The same-day surgery LC group demonstrated significantly lower preoperative fluid infusion, postoperative fluid infusion, total hospitalization costs, and a shorter total length of stay compared to the conventional inpatient LC group (P<0.05). Furthermore, the incidence of postoperative urinary retention was significantly lower in the same-day surgery LC group (P<0.05). ConclusionsThis study demonstrates that same-day surgery LC is a safe and feasible approach for appropriately selected patients. Its outcomes in key perioperative safety metrics are comparable to those of the conventional inpatient LC model, while it offers the significant advantages of effectively reducing the length of hospital stay, lowering medical costs, and decreasing the incidence of certain postoperative complications.