Benchmarking the perioperative process: III. Effects of regional anesthesia clinical pathway techniques on process efficiency and recovery profiles in ambulatory orthopedic surgery
Benchmarking the perioperative process: III. Effects of regional anesthesia clinical pathway techniques on process efficiency and recovery profiles in ambulatory orthopedic surgery
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DOI：
10.1016/s0952-8180(98)00083-x
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发表时间：
1998-11-01
影响因子：
6.7
通讯作者：
Watkins, WD
中科院分区：
文献类型：
--
作者：
Williams, BA;DeRiso, BM;Watkins, WD
研究目标：(1)将普通门诊骨科手术的区域麻醉方案纳入临床路径；(2)使用临床路径格式和麻醉临床主任协会(AACD)发布的程序时间术语表作为管理工具来衡量术后当日手术过程和出院结果；(3)确定全身、区域和联合全身-区域麻醉对这些过程和结果的影响。设计：回顾1995-1996学年和1996-1997学年连续接受前交叉韧带重建(ACLR)的患者的医院数据库和病历。以1995-1996年间不存在术中麻醉临床路径的患者资料作为历史对照。以1996~1997年间采用麻醉临床路径的手术患者为治疗组，地点：某教学医院门诊外科中心。测量方法及主要结果：对503例ASA分级为I、II级的患者进行回顾性分析。1996-1997年选择全身麻醉(+/-股神经阻滞)或硬膜外麻醉，此后围术期麻醉过程中使用的药物和设备标准化，1995-1996年患者在麻醉技术上不一定有选择，也没有关于特定药物和用品的标准化围术期麻醉过程。测量AACD程序时间词汇表中描述的时间间隔、麻醉药品和供应成本以及患者结局变量(术后护理干预和意外入院)，这些变量受所用麻醉技术的影响。在1996-1997年间，与单纯全身麻醉相比，ACLR的全身-区域麻醉联合护理导致药费和材料成本增加，周转时间增加。然而，使用联合技术的患者表现出更好的康复状况和更低的意外入院率，他们需要更少的护理干预来应对常见的术后症状。接受硬膜外麻醉的患者的出院结果与股神经阻滞全身麻醉的患者相似。与临床路径全身麻醉相比，临床路径区域麻醉患者采用麻醉后护理单元转流(快速通道)的可能性更大。结论：临床路径区域麻醉用于骨科门诊患者，在控制成本的同时，提高手术效率和患者预后方面具有显著的优势。(C)1998年，爱思唯尔科学公司。
Study Objectives: (1) To incorporate regional anesthesia options for common outpatient orthopedic surgery into clinical pathways; (2) to use the clinical pathway format and the Procedural Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as management tools to measure postoperative same-day surgery processes and discharge outcomes; and (3) io determine the effects of general, regional, and combined general-regional anesthesia on these processes and outcomes.Design: Hospital database and Patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995-1996 and 1996-1997. Patient data from AY 1995-1996, during which no intraoperative anesthesia clinical pathway existed, served as historical controls. Data from AY 1996-1997, during which intraoperative anesthesia clinical pathways were used, served as the treatment group.Setting: Ambulatory surgery center in a teaching hospital.Measurements and Main Results: The records of 503 ASA physical status I and II patients were reviewed. 1996-1997 patients selected general anesthesia (+/- femoral nerve block) or epidural anesthesia, after which the remainder of the perioperative anesthesia process was standardized with respect to the drugs and equipment used 1995-1996 patients did not necessarily have a choice in anesthesia technique and did not have a standardized perioperative anesthetic course with respect to specific drugs and supplies. Intervals described in the AACD Procedural Times Glossary, anesthesia drug and supply costs, and patient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by anesthesia technique used, were measured. Combined general-regional anesthesia care for ACLR in 1996-1997, when compared with general anesthesia alone led to increased pharmacy and materials costs and increased turnover lime. However, patients with the combined technique showed improved recovery profiles and lower unexpected admission rates, and they required fewer nursing interventions for common postoperative symptoms. Patients receiving epidural anesthesia showed discharge outcomes similar to those patients receiving general anesthesia with femoral nerve block. Postanesthesia care unit bypass (fast-tracking) was more likely in clinical pathway regional anesthesia patients, when compared with the clinical pathway general anesthesia used.Conclusions: Clinical pathway regional anesthesia care for outpatient orthopedics may have a significant rob in simultaneously containing costs and improving both process efficiency and patient outcomes. (C) 1998 by Elsevier Science Inc.