¿Es posible reducir la estancia en cirugía ginecológica benigna mediante la utilización de protocolos de asistencia?

• Felipe Ojeda ^[1] ; R.M. Miralles ^[2] ; M. de la Flor ^[2] ; B. Santacruz ^[1]
  1. [1] Fundación Hospital Alcorcón

     Fundación Hospital Alcorcón

     Alcorcón, España

     
  2. [2] Hospital Universitari de Tarragona Joan XXIII

     Hospital Universitari de Tarragona Joan XXIII

     Tarragona, España

     
• Localización: Revista de calidad asistencial, ISSN 1134-282X, Vol. 17, Nº 4, 2002, págs. 224-231
• Idioma: español
• DOI: 10.1016/S1134-282X(02)77509-X
• Enlaces
  • Texto completo
• Resumen
  • español

    Objetivo: Demostrar que una adecuada protocolización de la asistencia quirúrgica y posquirúrgica permite disminuir la estancia hospitalaria en la cirugía ginecológica laparotómica benigna sin aumentar la morbilidad y manteniendo los estándares de calidad.

    Pacientes y método: Comparamos la estancia media hospitalaria de dos grupos homogéneos de pacientes: uno control de 54 pacientes y otro de estudio de 53, con procesos benignos ginecológicos a las que se practicó cirugía laparotómica. Al grupo de estudio se le sometió a un protocolo definido para facilitar el alta lo más tempranamente posible.

    Resultados: Ambos grupos fueron comparables respecto al tipo de ingreso, de cirugía practicada, comorbilidad, complicaciones y situación al alta. La estancia preoperatoria no evidenció diferencia significativa (p = 0,20). La estancia hospitalaria fue de 7,8 días para el grupo control y de 6,1 para el de estudio, existió una diferencia significativa entre ambos (p = 0,004). En ninguno de los grupos se presentó reingreso antes de 30 días ni relacionados. No se registraron reclamaciones ni sugerencias relacionadas con la duración de la estancia en atención al paciente.

    Conclusiones: Resulta posible una reducción de la estancia hospitalaria posquirúrgica para procedimientos ginecológicos, y ésta actua de forma adecuada sobre los protocolos de cuidados postoperatorios.

  • English

    Objective: To demonstrate that appropriate protocols for surgical and postsurgical care reduce hospital stay after laparotomic procedures for benign gynecological disease and enable standards of health care quality to be maintained without increasing mortality.

    Patients and method: We compared the mean length of hospital stay in two homogeneous groups of patients: a control group of 54 patients and a study group of 53 patients with benign gynecological processes who underwent laparotomic surgery. A protocol designed to achieve hospital discharge as quickly as possible was applied in the study group.

    Results: In both groups, type of admission, the surgery performed, comorbidity, complications and length of stay were similar. No significant differences were found in preoperative stay (p = 0.20). Hospital stay was 7.8 days in the control group and 6.1 days in the study group. This difference was statistically significant (p = 0.004). There were no readmissions in the first 30 days in either group. No complaints or suggestions related to length of hospital stay were lodged in the Patient Affairs Unit.

    Conclusions: Length of hospital stay for gynecological procedures can be reduced by following protocols for postsurgical care.

• Referencias bibliográficas
  • Strong TH, Brown WL Jr, Brown WL, Curry CM. Experience with early postcesarean hospital dismissal. Am J Obstet Ginecol 1993;169:116-9.
  • Hackman B, Navaneethan N. Early discharge after gynaecological surgery. Eur J Obstet Gynecol Reprod Biol 1993;52:57-61.
  • Purdon TF. A guest editorial: Some macro and micro aspects of economics in Obstetrics and Gynecology. Obstet Gynecol Survey...
  • Farré MM, Massoni MA, Mías MC. Unidad de Hospitalización a domicilio del enfermo quirúrgico agudo. Todo Hospital 1997; 140:47-51.
  • Ponce J, Martí L, Pla MJ, Valls M, Balagueró L. Evolución de la técnica quirúrgica y las indicaciones de la histerectomía simple ...
  • Boyd ME, Groome PA. The morbidity of abdominal hysterectomy. CJS 1993;36:155-9.
  • Helmkamp BF, Krebs HB, Corbett SL, Trodden RM, Black PW. Radical hysterectomy: current management guidelines. Am J Obstet Gynecol 1997;177:372-4.
  • Nagele F, Molnár BG, O’Connor H, Magos A. Randomized stu- dies in endoscopic surgery –Where is the proof? Curr Opin Obstet Ginecol 1996;8:281-9.
  • Wood C, Maher P, Hill D. The declining place of abdominal hysterectomy in Australia. Gynecol Endoscop 1997;4:457-60.
  • Weber A, Lee J. Use of alternative techniques of hysterectomy in Ohio, 1988-1994. N Engl J Med 1996;335:483-9.
  • MacKenzie IZ. Reducing hospital stay after abdominal hysterectomy. Br J Obstet Gynaecol 1996;103:175-8.
  • ACOG Comittee Opinion. Comittee on Ginecologic Practice. Length of stay for gynecologic procedures. Nº134. Int J Gynecol Obstet 1993;45:183-262.
  • ACOG Comittee Opinion: Length of hospital stay for gynecologic procedures. N.º191. Int J Gynecol Obstet 1998;60:189.
  • DRGs. Diagnosis Related Groups. Definitions manual. Versión 10.0. 3M, 1998.
  • Web del Center for Disease Control de Atlanta (USA) [consultado 12/01/96]. Disponible en www.cdc.org.
  • CIM-9 MC. Barcelona: Generalitat de Catalunya. Departament de Sanitat i Seguretat Social, 1993.
  • Pittaway DE, Takacs P, Baugess P. Laparoscopic adnexectomy: a comparison with laparotomy. Am J Obstet Gynecol 1994; 171:385-9. Discussion:...
  • Tintara H, Leetanaporn R. Cost-benefit analysis of laparoscopic adnexectomy. Int J Gynaecol Obstet 1995;50:21-5.
  • Lin P, Falcone T, Tulandi T. Excision of ovarian dermoid cyst by laparoscopy and by laparotomy. Am J Obstet Gynecol 1995; 173:769-71.
  • Chatwani A, Yazigi R, Amnin-Hanjani S. Operative laparoscopy in the management of tubal ectopic pregnancy. J Laparoendosc Surg 1992;2:319-24.
  • Vu K, Gehlbach DL, Rosa C. Operative laparoscopy for the treatment of ectopic pregnancy in a residency program. J Reprod Med 1996;41:602-4.
  • Quinlan DJ, Towsend DE, Jonhson GH: Safe and cost-effective laparoscopic removal of adnexal masses. J Am Assoc Gynecol Laparosc 1997;4:215-8.
  • Arbogast JD, Welch RA, Riza DE, Ricaurte EL, Pieper DR: Laparoscopically assisted vaginal hysterectomy appears to be an alternative...
  • Daniell JF, Kurtz BR, Woodford HD: Laparoscopic assisted vaginal hysterectomy: one group’s experience. J Gynecol Surg 1994;10:155-8.
  • Martel MJ, Gilliland GB: Laparoscopically assisted vaginal hysterectomy: a review of 106 cases. J Laparoendosc 1995;5: 371-5.
  • Kung FT, Hwang FR, Lin H, Tai MC, Hsieh CH, Chang SY: Comparison of laparoscopically assisted vaginal hysterectomy and abdominla...
  • Johns DA, Carrera B, Jones J, DeLeon F, Vincent R, Dafely C. The medical and economic impact of laparoscopically assisted vaginal hysterectomy...
  • Dorsey JH, Steimberg EP, Holtz PM. Clinical indications for hysterectomy route: patients characteristics or physician preference?...
  • Meiklle SF, Nugent EW, Orleans M. Complications and recovery from laparoscopy-assisted vaginal hysterectomy compared with abdominal...
  • Bronitsky C, Payne RJ, Stuckey S, Wilkins D. A comparison of laparoscopically assisted vaginal hysterectomy vs traditional total abdominal...
  • Boike GM, Elfstrand EP, DelPriore G, Schumock D, Olley HS, Lurian JR. Laparoscopically assisted vaginal hysterectomy in a university...
  • Howard FM, Sanchez R. A comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy. J Gynecol Surg 1993;9:83-90.
  • Nezhat C, Bess O, Admon D, Nezhat CH, Nezhat F. Hospital cost comparison between abdominal, vaginal, and laparoscopy-assisted vaginal...
  • East M. Comparative cost of laparoscopically assisted vaginal hysterectomy. N Z Med J 1994; 07:371-4.
  • Casey MJ, Garciapadial J, Johnson C, Osborne NG, Sotolongo J, Watson P. A critical analysis of laparoscopic assisted vaginal hysterectomies...
  • Jones IS, Lapsely HM. Quality assurance applied to laparoscopically assisted vaginal hysterectomy: a pilot study. J Qual Clin Pract 1994;14:121-9.
  • Hidlebough D, Omara P, Conboy E. Clinical and financial analyses of laparoscopically assisted vaginal hysterectomy versus abdominal...
  • Carter JE, Ryoo J, Katz A. Laparoscopic-assisted vaginal hysterectomy: a case control comparative study with total abdominal hysterectomy....
  • Bernstein P, Fenton P, Walla K, Platt LD. Introduction of laparoscopically assisted vaginal hysterectomy in a private teaching community ...
  • Garcia-Padial J, Osborne N, Sotolongo J, Ferrer N. Laparoscopy-assisted vaginal hysterectomy compared with abdominal hysterectomy....
  • Bornstein SJ, Shaber RE. Laparoscopically assisted vaginal hysterectomy at a health maintenance organization; cost-effectiveness and...
  • Nezhat F, Nezhat C, Gordon S, Wilkins E. Laparoscopic versus abdominal hysterectomy. J Reprod Med 1992;37:247-50.
  • Phipps JH, John M, Nayak S. Comparison of laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy with...
  • Raju K, Auld BJ. A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral...
  • Summitt RL, Stowall TG, Lipscomb GH, Lin FW: Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standart...
  • Richardson RE, Bournas N, Magos AL. Is laparoscopic hysterectomy a waste of time? Lancet 1995;345:36-41.
  • Kevac SR. Guidelines to determine the route of hysterectomy. Obstet Gynecol 1995;85:18-23.
  • Lorenzo S. Revisión de utilización de recursos: estudios realizados en España. Rev Calidad Asistencial 1997;12:140-6.
  • Peiró S, Meneu R, Lorenzo S, Restuccia J. Assessing the ne- cessity of hospital stay by means of the appropriateness evaluation...
  • Hofer TP, Haiward RA. Can early readmission rates accurately detect poor-quality hospitals? Med Care 1995;33:234-45.
  • Welch HG, Larson EH. Readmission after surgery in Washington State rural Hospitals. Am J Public Health 1992;82:407-11.
  • Riley G, Lubitz J, Gornick M. Medicare beneficiaries: Adverse outcomes after hospitalization for eigth procedures. Med Care 1993;10:921-49.
  • Falcone T, Paraiso MF, Mascha E. Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal...
  • Serur E, Emeney PL, Byrne DW. Laparoscopic management of adnexal masses. J Soc Laparoendosc Surg 2001;5:143-51.
  • Pearson SD, Kleefield SF, Soukop JR, Cook EF, Lee TH. Clinical pathways intervention to reduce length of hospital stay. Am J Med 2001;110:175-80.