Financing health-care expenditure has become increasingly more difficult. Considering the high frequency of breast cancer, which affects one million women in the world each year, the reductions of medical expenditure for the treatment of this disease is highly desirable within the limits of medical efficiency and safety. One hundred and fifty patients with carcinoma of the breast underwent surgery in our department with one-day hospitalization. Patients were discharged with the drainage tube still in place and later treated in the out-patient setting, for dressing and checking the wound, and removing the stitches and drainage tube. Four cases of seroma were registered, all resolved by aspiration of the fluid in a single visit, 1 case of haematoma and 1 case of infection. Patients who underwent this short-stay treatment were amply satisfied. Our experience demonstrates that this type of treatment is both safe and effective. Moreover, it provides considerable benefits in terms of national health-care costs as well as being psychologically better for the patients.
[Show abstract][Hide abstract] ABSTRACT: Con il termine day-surgery s'intende la possibilità clini-ca, organizzativa ed amministrativa di effettuare interventi chi-r u rgici o procedure diagnostiche e/o terapeutiche invasive e semiinvasive in regime di ricovero limitato alle sole ore del giorno, in anestesia locale, loco-regionale o generale (1) . Scopo del nostro lavoro è di valutare l'attività di day-surgery integrata nel nostro reparto di chirurgia generale. Parole chiavi: day surgery SUMMARY By attending a day surgery unit, patients are able to have an operations, in general or local anaesthesia, or minimally invasive diagnostic procedure, without the need for an overni -ght stay in Hospital. Aim of this study is to describe advantages and disvantanges of this approach by autor's experience.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the feasibility and efficacy of outpatient surgery for early breast cancer in an Italian ambulatory setting and to assess its benefits.
A review of 88 women treated for breast cancer from an outpatient facility was undertaken from July 2003 to December 2006. The patients were selected for ambulatory surgery according to specific social, environmental, physical and oncological criteria.
Eighty-eight women underwent a total of 107 surgical interventions in an ambulatory setting. Sixty out of the eighty-eight patients (68%) received a one-day conclusive surgical treatment, and the remaining 28 patients were promptly treated in two phases. Among this latter group, 18 patients (68%) were treated only in an outpatient facility, whereas the other 10 patients require reintervention with hospitalization. There were no intraoperative complications. In the postoperative period, 14 complications were observed: 6 wound infections, 3 hematomas, 1 axillary seroma and 4 readmissions. The patients' readmissions were due to nausea and emesis in one case, disphnoea in another case, and only two readmissions were due to surgical complications (hematoma in both cases). Patients that were interviewed exhibited a high level of satisfaction from the treatments they received.
This study confirms the feasibility, efficacy and safety of the outpatient setting regime, which is highly appreciated by women and is more cost effective than surgery in a hospital setting.
International Journal of Surgery (London, England) 01/2009; 6 Suppl 1:S116-8. DOI:10.1016/j.ijsu.2008.12.006 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over the last decade, breast cancer surgery has become less invasive and potentially suitable for day surgery. The aim of this systematic review was to establish the benefits and disadvantages of day surgery for breast cancer.
A systematic search of the Cochrane Library, Medline, British Nursing Index, CINAHL, EMBASE and PsycINFO was carried out. All relevant papers were assessed for their methodological quality using a checklist designed to assess both randomised and non-randomised studies with specific questions added to address outcome measures.
No randomised controlled trials were found in literature. Eleven observational studies were included. The rate of discharge after day surgery was universally high with very low acute readmission rates. Intractable vomiting, patient anxiety and pain control were the main reasons for failing discharge. Patient satisfaction with day surgery was high and psychological recovery was quicker, however, majority of the studies did not use validated questionnaires. The hospital costs were lower for day surgery.
Day surgery for breast cancer is safe, with equivalent complication rates, but there is lack of evidence from randomised controlled trials. Patient satisfaction and psychological well-being is high. Further trials with validated questionnaires are required to confirm this.
International Journal of Surgery (London, England) 06/2009; 7(4):318-23. DOI:10.1016/j.ijsu.2009.04.015 · 1.53 Impact Factor
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