クリティカルパスの使用による大腸ポリペクトミーの日帰り手術への移行

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  • Transition to day-surgery for colonic polypectomy using critical path method
  • クリティカルパス ノ シヨウ ニ ヨル ダイチョウ ポリペクトミー ノ ヒガエリ シュジュツ エ ノ イコウ

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[Aim] We have used critical path of colonic polypectomy since 1988. The patients had been hospitalized for one day after polypectomy. To shift to day-surgery, the variances of CP and complications of polypectomy were analyzed. [Methods] In the first CP, patients had been hospitalized for one day to observe accidental symptom. After using the CP for 2 years, we analyzed its variances and complications. Then, the CP was modified as day-surgery protocol. The efficacy of day-surgery was analyzed as the differences of the number of polypectomy and number of colonoscopy. [Results] Polypectomy was performed with 260 cases for 2 years and patients were hospitalized for a day. The size of polyps was ranged from 5mm to 30mm, less than five polyps were removed at once. No complication occurred during hospitalization period. One of 260 cases (0.38%) was bled at day 4 after polypectomy. One polyp (10mm) was removed at once in this case. From this res ult, we concluded that one-day hospitalization after polypectomy was not able to avoid complications. Therefo re, we shifted to day-surgery. After introduction of day-surgery, no complication has occurred in 205 cases for a year. The number of polypectomy has shown a year-on-year increase of 46% after transition to day-surgery. [Conclusion] Transition to day-surgery of colonic polypectomy is succeeded with analyze of variances of CP. The day-surgery of colonic polypectomy reduces the burden on the patients, and it increases the number of treatment.

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