Taking the Breast Surgery Department of the Second Affiliated Hospital Zhejiang University School of Medicine as an example, this paper introduces the quality management experience of day surgery case settlement checklist. Through the establishment of diagnosis-related groups (DRGs) settlement checklist quality control review mechanism, the introduction of DRGs information system to monitor the quality of settlement checklist in real time, and strengthening the supervision of low-rate cases and other measures, the quality of medical insurance fund settlement checklist and the accuracy of case enrollment have been effectively improved, and the occurrence of low-rate cases has been reduced. On the whole, day surgery and DRGs payment jointly promote the effective improvement of medical service efficiency and the reasonable allocation of medical resources, and reduce the average cost per patient and the average length of hospital stay.
ObjectiveTo analyze the current situation of day surgery patients’ withdrawal from hospitalization, and put forward reasonable and effective measures and suggestions.MethodsDescriptive statistical analysis and trend chi-square test were conducted on the hospitalization withdrawal rate of day surgery in the Day Surgery Ward of the Second Affiliated Hospital Zhejiang University School of Medicine from 2012 to 2020. The reasons for hospitalization withdrawal and the operation methods of withdrawn cases from 2019 to 2020 were descriptively analyzed.ResultsFrom 2012 to 2020, the hospitalization withdrawal rate of day surgery decreased from 4.48% to 2.19%, with a significant decrease and a linear downward trend (χ2trend=138.500, P<0.001). From 2019 to 2020, patient factor was the most important reason for hospitalization withdrawal of day surgery, accounting for 79.72%; secondly, long waiting time for surgery, abnormal examination results, inadequate preoperative evaluation, medical insurance reimbursement, epidemic situation in 2020 and other reasons had affected the patients’ hospitalization withdrawal of day surgery to varying degrees. Endoscopic lithotripsy accounted for the largest proportion (210 cases, accounting for 20.87%) in the withdrawn procedures from 2019 to 2020, followed by minimally invasive rotary resection for breast lesions (126 cases, accounting for 12.52%).ConclusionImproving preoperative evaluation, strengthening preoperative communication, implementing efficient medical treatment, and shortening the waiting time for surgery can reduce the rate of hospitalization withdrawal of day surgery.
Objective To investigate the risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. Methods The clinical data of patients with liver metastases treated by radiofrequency ablation in our hospital from January 2010 to April 2022 were collected retrospectively and analyzed by univariate and multivariate logistic regression analysis. Results A total of 57 patients were included in the study, and the total number of postoperative infections was 19 (33.33%). Univariate logistic regression analysis showed that the tumor location, maximum tumor diameter, number of tumors, ablation times, and ablation duration were related to the occurrence of infection after radiofrequency ablation (P<0.01). The results of multivariate logistic regression analysis showed that the tumor location [OR=6.45, 95%CI (1.11, 37.35), P=0.037] and ablation duration [OR=1.49, 95%CI (1.16, 1.91), P=0.002] were independent risk factors for infection after radiofrequency ablation in patients with choledocho-jejunostomy. Conclusions For patients with metastatic liver cancer with a history of choledochojejunostomy, the tumor location and the duration of ablation are closely related to postoperative infection. We should strengthen the indivi-dualized management of such patients during and after operation should be strengthened to promote disease recovery.
ObjectiveTo establish a model for predicting microvascular invasion (MVI) of hepatocellular carcinoma based on magnetic resonance imaging (MRI) radiomics features.MethodsThe clinical and pathological datas of 190 patients with hepatocellular carcinoma who received surgical treatment in our hospital from September 2017 to May 2020 were prospectively collected. The patients were randomly divided into training group (n=158) and test group (n=32) with a ratio of 5∶1. Gadoxetate disodium (Gd-EOB-DTPA) -enhanced MR images of arterial phase and hepatobiliary phase were used to select radiomics features through the region of interest (ROI). The ROI included the tumor lesions and the area dilating to 2 cm from the margin of the tumor. Based on a machine learning algorithm logistic, a radiomics model for predicting MVI of hepatocellular carcinoma was established in the training group, and the model was evaluated in the test group.ResultsSeven radiomics features were obtained. The area under the receiver operating characteristic curve (AUC) of the training group and the test group were 0.830 [95%CI (0.669, 0.811)] and 0.734 [95%CI (0.600, 0.936)], respectively.ConclusionThe model based on MRI radiomics features seems to be a promising approach for predicting the microvascular invasion of hepatocellular carcinoma, which is of clinical significance for the management of hepatocellular carcinoma treatment.