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Gynaecological day surgery at a Hong Kong hospital
1Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong.
Insights
Gynaecological day surgery in Hong Kong improved significantly, reducing prolonged hospital stays from 15.6% to 7.4%. Better patient selection and counselling are key for optimizing day surgery outcomes.
Area of Science:
- Gynaecology
- Surgical Practice
- Health Services Research
Background:
- Day surgery is increasingly utilized in gynaecology.
- Optimizing patient selection and practice management is crucial for successful day surgery programs.
Purpose of the Study:
- To evaluate the outcomes of gynaecological day surgery in a Hong Kong practice.
- To identify factors associated with prolonged hospital stay and cancellations.
- To assess the impact of practice evolution on day surgery efficiency.
Main Methods:
- Retrospective review of patients undergoing gynaecological day surgery.
- Analysis of data from October 1993 to June 1994, with initial and subsequent periods compared.
- Statistical analysis to identify predictors of prolonged stay and cancellations.
Main Results:
- Initial day patient rate was 49.5%, with a prolonged hospital stay rate of 15.6%.
- In the subsequent period, prolonged hospital stay decreased to 7.4%, while cancellation rates remained stable (3.0% vs 3.6%).
- Factors associated with prolonged stay included non-Chinese ethnicity, comorbidities, American Society of Anesthesiologists Class II, and intraperitoneal procedures. Non-medical issues accounted for 37.4% of prolonged stays.
Conclusions:
- Gynaecological day surgery outcomes can be improved through dedicated facilities and enhanced patient counselling and selection.
- Addressing non-medical factors is important for reducing prolonged hospital stays.
- Continuous quality improvement is essential for efficient day surgery practices.
Abstract:
A retrospective review was made of patients who underwent day surgery at a gynaecological day practice in Hong Kong from October 1993 to June 1994. The first three months of practice, which involved 326 patients, was analysed separately. During the initial period, 49.5% of patients who had gynaecological operations were managed as day patients. The rates for patients with prolonged hospital stay and cancelled operations were 15.6% and 3.0%, respectively. In the subsequent period, the incidence of prolonged hospital stay decreased to 7.4%, while the cancellation rate was similar, at 3.6%. Patients with a prolonged hospital stay were less likely to be Chinese, were more likely to have other medical problems, to be of American Society of Anesthesiologists Class II, and to have procedures that involved opening of the peritoneal cavity. Non-medical problems were an important reason for prolonged hospital stay (37.4%). The stay rate could be reduced by provision of a separate operating facility and by improved counselling and selection of patients.