Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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The Health Care Structure Act has provided incentives for outpatient surgery; 50% is now being performed outside the hospital. Additional incentives are to be provided for outpatient nursing care. An outpatient surgery is only economically efficient in cooperative practices.
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Day surgery has been practised in Great Britain for many years. However, only in the last few years there has been a great surge of interest in the practice of day surgery. This has taken place despite many obstacles such as clinician's preference for more traditional approaches and initial lack of facilities and resources. ⋯ However, there is a wide variation in relation to performance of day surgery throughout the country between hospitals. This is true both for total number of surgical patients treated on a day care basis and for individual surgical procedures. Day surgery is now generally accepted as best option of treatment for over 50% of all elective surgical procedures and it is expected that by the end of this decade this figure is likely to be over 60%.
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Over the last twenty years, the most dramatic change in American surgical care has been the shift from inpatient to outpatient surgical care. Ambulatory surgery in the 1990s, with its demonstrated ability to lower individual patient and overall societal surgical care costs, while maintaining quality equal to inpatient services, has been embraced by all segments of the American health care delivery system. ⋯ It also appears likely that ever increasing numbers of surgical operations will be completed on an outpatient basis. Ambulatory surgery is one of those rare socioeconomic-political movements in which all participants have benefitted as demonstrated by public interest and demand, surgeon satisfaction, patient participation, and, most importantly, payer encouragement and mandate.
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Existing scoring systems have failed to reflect the pathophysiological changes during ICU therapy, and do not provide reliable criteria for the prediction of outcome in surgical patients. The aim of the present project was to establish a comprehensive scoring system for daily evaluation of physiological parameters and therapeutic interventions in a surgical intensive care unit, and to identify score patterns in the course of ICU treatment to be used for prospective clinical decisions. In a prospective study of 123 consecutive patients who required intensive care for more than two consecutive days we documented 10 physiological parameters and a set of 14 therapeutic interventions on a daily basis over a total of 1274 days. ⋯ At that point, HDWS was superior to APACHE II with respect to the predictive power as assessed by receiver operator characteristic curves. No patient who fulfilled all four unfavorable HDWS-patterns during the first week of ICU treatment survived (but these were only two patients). We conclude that the limited power of scores obtained on admission to predict outcome in surgical patients may be improved by trend analysis of scores over time which also take into account the patients' response to therapy.(ABSTRACT TRUNCATED AT 250 WORDS)