Outpatient parotidectomy

Article Abstract:

As part of a strategy to reduce unnecessary hospital stays, many operations are now performed on an outpatient basis. Outpatient thyroidectomy (removal of the thyroid gland) has been performed successfully, and since simple parotidectomy (excision of the parotid gland) also has a low complication rate, the possibility performing this procedure on an outpatient basis was also considered. The parotid glands are the largest pair of salivary glands, which lie at the side of the face just below and in front of the ear. A report is presented of 54 patients who underwent parotid operations on an outpatient basis over a five-year period. Patients ranged in age from 13 to 88 (average 48 years). All patients complained of a mass in the parotid area. Outpatient surgery was considered if there were no medical contraindications, the patient lived in the area of the hospital, the mass was small-to-moderate size and suspected to be benign, and the patient was considered to be psychologically suitable for an outpatient operation. If at the time of surgery it was found that the patient had cancer, more extensive surgery was performed, and the patient was admitted to the hospital. Of the 54 patients, 10 were admitted to the hospital after the surgery, and 44 were discharged the day of surgery. The reasons for hospital admission included: cancer (four patients); patient request (two patients); and complications (four patients). The complications were hematoma (blood blister) in two patients, and intractable nausea and vomiting in the two other patients. At interviews after operation, there was almost uniform patient satisfaction with the outpatient procedure. The average cost for inpatient surgery (discharge on the second day after surgery) was calculated to be $6,251 compared with $5,507 for the outpatient procedure; a savings of $744 per operation. It is concluded that outpatient parotid surgery can be safe and cost-effective in selected patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Economic aspects, Surgery, Parotid glands, Surgery, Outpatient, Ambulatory surgery, Head and neck tumors, Parotidectomy

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Empiric outpatient management of HIV-related pneumonia: economical or unwise?

Article Abstract:

It may be possible to treat carefully selected patients with human immunodeficiency virus (HIV)-associated pneumonia infections on an outpatient basis without comprehensive testing. A researcher presented selection criteria for identifying suitable patients with HIV-associated pneumonia to treat as outpatients rather than admitting them to the hospital for specific identification of the infection and supervised treatment. Dependable patients with CD4 counts less than 200 and an uncomplicated pneumonia infection who can take oral medications may be suitable for outpatient treatment. Patients living in areas of the world where tuberculosis, coccidiomycosis or histoplasmosis are common may require further testing to more accurately identify the cause of infection. Recommended treatment may include trimethoprim-dapsone, trimethoprim-sulfamethoxazole, or clindamycin-primaquine.

Care and treatment, Editorial, Complications and side effects, HIV infection, HIV infections, Pneumocystis carinii pneumonia, Ambulatory medical care, Ambulatory care utilization

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Validation of cause-of-death certification for outpatient cancers: the contrasting cases of melanoma and mycosis fungoides

Article Abstract:

Researchers in this study aimed to evaluate the validity of mortality estimation from death certificates of cancers such as melanoma and mycosis fungoides. Their method estimated that 93% of the deaths were correctly certified as a result of melanoma, but only 60% of the deaths caused by mycosis fungoides were reported correctly.

Patient outcomes, Mortality, Causes of, Death, Melanoma, Certification, Mycosis fungoides, False certification

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