Outpatient surgical proctology: past, present and future

Sobrado, Carlos Walter

doi:10.1590/s0004-28032005000300001

Cited by 7 publications

(10 citation statements)

References 11 publications

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“…Anorectal procedures account for around 80% of all coloproctology surgeries 28 and among these procedures, more than 90% may be performed in ambulatory facilities 4,5,15 . A series of cases published by Steckert et al that analyzed 430 patients submitted to 453 anorectal surgeries, described hemorrhoidectomy as the most frequent procedure, corresponding to 50.3% of total surgeries 28 .…”

Section: Discussionmentioning

confidence: 99%

“…Until the 1970's, almost all anorectal surgeries used to be performed in the hospital environment, regardless of the procedure complexity 5 . Following the global economy tendencies towards optimization of financial resources, ambulatory surgeries have gained increasing and gradual acceptance from surgeons 29,30 .…”

Section: Discussionmentioning

confidence: 99%

“…Following the global tendencies for small surgical procedures in patients with favorable anesthetic conditions, hemorrhoidectomy, just as most procedures in the anorectum, may be performed in ambulatory facilities 4,5 . In the context of anorectal surgeries in ambulatory facilities, the anesthetic technique is extremely important and should enable good surgery conditions, agility in the surgery room, possibility optimize the anesthetic technique employed in these surgeries, without negative impacts to patients or health systems.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

Kotze¹,

Junior²,

Freitas³

et al. 2011

J. Coloproctol. (Rio J.)

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There is no consensus on the ideal anesthesia for hemorrhoidectomy in ambulatory facilities. Spinal anesthesia and venous propofol associated with local perianal block (combined anesthesia) are frequently used, and their direct costs may be crucial for the anesthesia type selection. The objective of this study was to compare the direct costs of anesthesia-related materials in hemorrhoidectomy between these two anesthetic techniques.Retrospective and cross-section analysis, comparing the direct costs of the materials of spinal and venous anesthesia with propofol associated with local perianal block, in hemorrhoidectomy. Twenty patients were included, ten submitted to each anesthesia type (five from each gender). The mean age in the spinal anesthesia group was 46.5 years and in the combined anesthesia group, 42.5 years (p=0.334). The mean cost of anesthesia-related materials was R$ 58.50 (R$ 36.48 - R$ 85.79) in the first group versus R$ 190.31 (R$ 98.16 - R$ 358.51) in the second - 69.27% difference between them (p<0.001). The mean costs according to gender analysis were R$ 50.32 and R$ 66.69 (p=0.263) in the spinal anesthesia group versus R$ 222.52 and R$ 158.10 (p=0.221) in the combined anesthesia group, respectively. The direct costs of anesthesia-related materials were significantly lower in patients submitted to hemorrhoidectomy using spinal anesthesia. No difference was observed between the genders in each group analyzed.
Não há consenso sobre a técnica anestésica de escolha para hemorroidectomias em regime ambulatorial. A raquianestesia e a anestesia combinada (venosa com propofol + local) são frequentemente utilizadas, e os custos das mesmas podem ser determinantes na escolha do melhor tipo de anestesia. O objetivo deste trabalho foi avaliar e comparar os custos diretos dos materiais anestésicos utilizados em hemorroidectomias entre essas duas técnicas. Foi feito um estudo retrospectivo e transversal, comparativo entre os custos diretos dos materiais anestésicos entre a raquianestesia e a anestesia venosa com poropofol associada ao bloqueio perianal local, em hemorroidectomias. Foram analisados 20 pacientes, 10 operados com cada técnica anestésica (5 de cada gênero). A média de idade do grupo da raquianestesia foi de 46,5 anos e do grupo da anestesia combinada foi de 42,5 anos (p=0,334). O custo médio do procedimento anestésico no primeiro grupo foi de R$ 58,50 (R$ 36,48 - R$ 85,79), no segundo foi de R$ 190,31 (R$ 98,16 - R$ 358,51). A diferença das médias foi de 69,27%, com significância estatística (p<0,001). A média dos custos dos gêneros masculino e feminino no grupo da raquianestesia foi de R$ 50,32 e R$ 66,69 (p=0,263) e no grupo da anestesia combinada foi de R$ 222,52 e R$ 158,10 (p=0,221), respectivamente. Os custos diretos médios dos materiais anestésicos dos pacientes submetidos a hemorroidectomias foram significativamente menores no grupo da raquianestesia. Não houve significância estatística na diferença entre os gêneros em cada grupo

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

Kotze¹,

Junior²,

Freitas³

et al. 2011

J. Coloproctol. (Rio J.)

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“…In addition, significant cost savings have been reported to drive a large part of the movement toward ambulatory surgery in general. 52 Ambulatory surgery appears to be more cost effective than inpatient procedures. Numerous charges are avoided with ambulatory surgery including the cost of admission, use of ward-based supplies, respiratory therapy, increased medication costs, and laboratory charges.…”

Section: Cost and Safety Of Ambulatory Anorectal Surgerymentioning

confidence: 99%

Perioperative Management of the Ambulatory Anorectal Surgery Patient

Shaw

Ternent

2016

Clinics in Colon and Rectal Surgery

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Ambulatory surgery is appropriate for most anorectal pathology. Ambulatory anorectal surgery can be performed at reduced cost compared with inpatient procedures with excellent safety, improved efficiency, and high levels of patient satisfaction. Several perioperative strategies are employed to control pain and avoid urinary retention, including the use of a multimodal pain regimen and restriction of intravenous fluids. Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions.

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“…Benign proctological problems including haemorrhoids, anal fissure, perianal abscess and cryptogenic anal fistula are common [1] with a limited assessment of the value of ambulatory surgery (completion of surgery and discharge within a 24-h period). It is anticipated that an ambulatory approach towards selected benign anorectal disease will accrue the benefits of ambulatory surgery for other conditions, namely a more rapid return to work and an overall reduced hospital and social cost [2–4]. The limited data shows such advantage in a range of benign anorectal conditions including fissure, haemorrhoids, fistula, pilonidal sinus, anal condylomata and perianal abscesses [5].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of ambulatory surgery for anal fistula with LIFT procedure

et al. 2019

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Background Ambulatory surgery maintains the advantages of a more rapid return to work and overall reduced hospital costs. The specific impact of ambulatory surgery for anal fistula using the LIFT procedure (ligation of the intersphincteric fistula tract) is presented. Methods A total of 218 consecutive patients with anal fistula who underwent ambulatory LIFT surgery were retrospectively compared with 386 cases managed as in-patients. Patient demographics, comorbidities, postoperative morbidity and pain as well as readmission rates within 30 days and satisfaction ratings were compared between the two groups. Results When compared with patients undergoing in-patient surgery, those in the ambulatory group were younger with a better level of education ( P < 0.05). Ambulatory cases returned to work after shorter postoperative periods ( P < 0.01) but experienced more frequent postoperative external hemorrhoidal thrombosis and more reported postoperative pain ( P < 0.05). There were no differences in the overall rate of complications or readmissions between the two groups. Ambulatory patients reported higher satisfaction ratings than in-patients ( P < 0.05). Conclusions The LIFT procedure for anal fistula can be safely performed in the ambulatory setting resulting in an acceptable level of satisfaction and a more rapid return to work when compared with in-patient fistula management.

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Outpatient surgical proctology: past, present and future

Cited by 7 publications

References 11 publications

Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

Perioperative Management of the Ambulatory Anorectal Surgery Patient

Feasibility of ambulatory surgery for anal fistula with LIFT procedure

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