Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000036.xml
Laryngorhinootologie 2024; 103(11): 788-796
DOI: 10.1055/a-2353-2347
DOI: 10.1055/a-2353-2347
Leitlinien und Empfehlungen
Ambulante Durchführung rhinochirurgischer Operationen unter Berücksichtigung des Einsatzes von Nasentamponaden
Positionspapier der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie, der Arbeitsgemeinschaft Rhinologie/Rhinochirurgie (ARHIN) der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie und des Deutschen Berufsverbandes der HNO-ÄrzteSinunasal surgery as outpatient procedure with special consideration of nasal packingPosition paper of the German Society of Otorhinolaryngology, Head and Neck Surgery, the working group Rhinology/Rhinosurgery (ARHIN) of the German Society of Otorhinolaryngology, Head and Neck Surgery and German Professional Association of Otorhinolaryngologists
Zusammenfassung
Hintergrund Die Ambulantisierung rhinochirurgischer Eingriffe wird derzeit intensiv diskutiert und insbesondere von politischer Seite stark propagiert. Viele Fragen zur Stratifizierung in ambulante oder stationäre Durchführung sind unklar. Insbesondere das Vorgehen bei Anwendung von Nasentamponaden ist bisher nicht ausreichend diskutiert.
Material und Methoden Entwicklung einer Checkliste zur ambulanten Durchführung rhinochirurgischer Operationen unter Berücksichtigung der aktuellen Literatur.
Ergebnisse und Schlussfolgerungen Nach umfassender Auswertung der Literatur und Analyse von Risikofaktoren wird eine Liste von stationär durchzuführenden rhinochirurgischen Operationen definiert. Es wird eine Checkliste für die ambulante oder stationäre Durchführung rhinochirurgischer Operationen vorgelegt, die soziale, allgemeine medizinische und spezifische operationsbedingte Gründe berücksichtigt und hierbei die Anwendung von Nasentamponaden einschließt. Sie wird ergänzt durch eine Checkliste, anhand derer Kriterien die Entlassungsfähigkeit von Patienten nach einer ambulant geplanten rhinochirurgischen Operation bewertet wird.
Abstract
Objective Currently, there is an intensive discussion on advancing and expanding outpatient rhinosurgical procedures. Many questions about how to stratify into out- and inpatient procedures are still not sufficiently clarified. Particularly, the use of nasal packing materials is not adequately discussed.
Material and Methods Development of a checklist to stratify sinunasal procedures into in- or outpatient procedures with consideration of current scientific literature and risk factors.
Results and conclusions After comprehensive assessment of the literature and analysis of specific risk factors, a list of sinunasal procedures is presented, which should be performed as inpatient procedures. We present a checklist for in- and outpatient sinunasal procedures, which considers social, medical and surgical factors as well as the use of nasal packing materials. Furthermore, a checklist is added to assess, whether patients are ready for discharge after a planned outpatient procedure.
Schlüsselwörter
Rhinochirurgie - Nasennebenhöhlenoperation - Ambulantisierung - stationäre Durchführung - Nasentamponade - Komplikationen - Blutung - Aspiration - Checkliste - EntlassfähigkeitKeywords
Sinunasal surgery - FESS - nasal packing - complications - postoperative bleeding - aspiration - outpatient procedure - inpatient procedure - checklist - discharge managementPublication History
Article published online:
30 September 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Löhler J, Delank W, Drumm S. et al. Considerations for the Performance and Quality Assurance of Outpatient Surgery in Otorhinolaryngology, Head and Neck Surgery in Germany. Laryngorhinootologie 2022; 101: 866-875 DOI: 10.1055/a-1946-1458. (PMID: 36257337)
- 2 Deitmer T, Dietz A, Delank K-W. et al. Ambulantes Operieren in der HNO-Heilkunde in Deutschland. Laryngorhinootologie 2021; DOI: 10.1055/a-1418-9745.
- 3 Schuldt T, Ovari A, Guder E. et al. Inpatient vs. outpatient costs analysis of septumplasty in Germany. Laryngorhinootologie 2015; 94: 18-24 DOI: 10.1055/s-0034-1377006. (PMID: 25111448)
- 4 Bhattacharyya N. Ambulatory sinus and nasal surgery in the United States: Demographics and perioperative outcomes. The Laryngoscope 2010; 120: 635-638 DOI: 10.1002/lary.20777. (PMID: 20058315)
- 5 de Gabory L, Serrano E, Lecanu J-B. et al. French Otorhinolaryngology Society guidelines for day-case nasal surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132: 35-40 DOI: 10.1016/j.anorl.2014.09.001. (PMID: 25540991)
- 6 Eckhardt H, Kreutzberg A, Busse R. Tageschirurgie – internationale Erfahrungen, Vergütungssysteme und finanzielle Anreize in England, Frankreich und Österreich. Arthroskopie 2024; 37: 3-10 DOI: 10.1007/s00142-023-00650-x.
- 7 Georgalas C, Obholzer R, Martinez-Devesa P. et al. Day-case septoplasty and unexpected re-admissions at a dedicated day-case unit: a 4-year audit. Ann R Coll Surg Engl 2006; 88: 202-206 DOI: 10.1308/003588406X95039. (PMID: 16551420)
- 8 Hopkins C, Browne J, Slack R. et al. Variation in day-case nasal surgery – why cannot we improve our day-case rates?. Clin Otolaryngol 2007; 32: 12-18 DOI: 10.1111/j.1365-2273.2007.01368.x. (PMID: 17298304)
- 9 Weber RK. Comprehensive review on endonasal endoscopic sinus surgery. Laryngorhinootologie 2015; 94 (Suppl. 01) S64-S142 DOI: 10.1055/s-0035-1545353. (PMID: 26770282)
- 10 Baumbach P, Dreiling J, Arnold C. et al. Pain after outpatient surgical procedures—a survey of 330 000 patients. Deutsches Ärzteblatt international 2024; DOI: 10.3238/arztebl.m2023.0235.
- 11 Belleudy S, Kérimian M, Legrenzi P. et al. Assessment of quality and safety in rhinologic day surgery. European Annals of Otorhinolaryngology, Head and Neck Diseases 2021; 138: 129-134 DOI: 10.1016/j.anorl.2020.06.019.
- 12 Bhattacharyya N. Unplanned revisits and readmissions after ambulatory sinonasal surgery: Unplanned Revisits after Sinonasal Surgery. The Laryngoscope 2014; 124: 1983-1987 DOI: 10.1002/lary.24584. (PMID: 24390859)
- 13 Eisenberg G, Pérez C, Hernando M. et al. Nasosinusal endoscopic surgery as major out-patient surgery. Acta Otorrinolaringol Esp 2008; 59: 57-61 (PMID: 18341861)
- 14 Ganesan S, Prior AJ, Rubin JS. Unexpected overnight admissions following day-case surgery: an analysis of a dedicated ENT day care unit. Ann R Coll Surg Engl 2000; 82: 327-330 (PMID: 11041031)
- 15 Gengler I, Carpentier L, Pasquesoone X. et al. Predictors of unanticipated admission within 30 days of outpatient sinonasal surgery. Rhinology 2017; 55: 274-280 DOI: 10.4193/Rhino16.251.
- 16 Kérimian M, Bastier P-L, Réville N. et al. Feasibility study of bilateral radical ethmoidectomy in ambulatory surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135: 377-382 DOI: 10.1016/j.anorl.2018.08.002. (PMID: 30126729)
- 17 Lecanu J-B, Pages L, Lazard D. et al. Outpatient bilateral ethmoidectomy in a private non-profit structure: Retrospective study of 204 patients. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139: 13-16 DOI: 10.1016/j.anorl.2021.05.003. (PMID: 34083168)
- 18 Lee JT, DelGaudio J, Orlandi RR. Practice Patterns in Office-Based Rhinology: Survey of the American Rhinologic Society. Am J Rhinol Allergy 2019; 33: 26-35 DOI: 10.1177/1945892418804904. (PMID: 30306790)
- 19 Menezes AS, Guimarães JR, Breda M. et al. Septal and turbinate surgery: is overnight essential?. Eur Arch Otorhinolaryngol 2018; 275: 131-138 DOI: 10.1007/s00405-017-4813-3. (PMID: 29159751)
- 20 Oker N, Dupuch V, Herman P. et al. Outcomes of endoscopic ethmoidectomy performed on a day-case basis: a prospective bi-centric study. Eur Arch Otorhinolaryngol 2017; 274: 305-310 DOI: 10.1007/s00405-016-4263-3. (PMID: 27535844)
- 21 Scott JR, Sowerby LJ, Rotenberg BW. Office-based rhinologic surgery: A modern experience with operative techniques under local anesthetic. Am J Rhinol Allergy 2017; 31: 135-138 DOI: 10.2500/ajra.2017.31.4414. (PMID: 28452711)
- 22 Tewfik MA, Frenkiel S, Gasparrini R. et al. Factors affecting unanticipated hospital admission following otolaryngologic day surgery. J Otolaryngol 2006; 35: 235-241 DOI: 10.2310/7070.2006.0018. (PMID: 17176798)
- 23 Hosemann W. Comprehensive review on danger points, complications and medico-legal aspects in endoscopic sinus surgery. Laryngorhinootologie 2013; 92: S88-136 DOI: 10.1055/s-0033-1337908. (PMID: 23625709)
- 24 Weber R, Draf W. Complications of endonasal micro-endoscopic ethmoid bone operation. HNO 1992; 40: 170-175 (PMID: 1612932)
- 25 Briner HR, Leunig A, Schlegel C. et al. Preoperative risk assessment for ambulatory sinonasal surgery. Eur Arch Otorhinolaryngol 2021; 278: 1455-1461 DOI: 10.1007/s00405-020-06435-4. (PMID: 33090277)
- 26 Re M, Massegur H, Magliulo G. et al. Traditional endonasal and microscopic sinus surgery complications versus endoscopic sinus surgery complications: a meta-analysis. Eur Arch Otorhinolaryngol 2012; 269: 721-729 DOI: 10.1007/s00405-011-1744-2. (PMID: 21984058)
- 27 Hosemann W. HOT TOPIC: Komplikationen der Nasennebenhöhlenchirurgie. 2023
- 28 Erdmann M. Prospektive Studie zur Wertigkeit der präoperativen Gerinnungsanamnese und Nachblutungshäufigkeit der Operationen bei Patienten einer Hals-Nasen-Ohren-Universitätsklinik. Prospective study on the value of the preoperative standardized bleeding history and frequency of rebleeding in patients of a University Department of Otolaryngology 2019. https://nbn-resolving.org/urn:nbn:de:gbv:9-opus-39874
- 29 Singh G, McCormack D, Roberts DR. Readmission and overstay after day case nasal surgery. BMC Ear Nose Throat Disord 2004; 4: 2 DOI: 10.1186/1472-6815-4-2. (PMID: 15500692)
- 30 Weber RK. Nasal packing and stenting. Laryngorhinootologie 2009; 88: S139-155 DOI: 10.1055/s-0028-1119504. (PMID: 22073095)
- 31 Weber RK, Sommer F, Heppt W. et al. Fundamentals and practice of the application of nasal packing in sinonasal surgery. HNO 2024; 72: 3-15 DOI: 10.1007/s00106-023-01369-9. (PMID: 37845539)
- 32 Orlandi RR, Lanza DC. Is nasal packing necessary following endoscopic sinus surgery?. Laryngoscope 2004; 114: 1541-1544 DOI: 10.1097/00005537-200409000-00007. (PMID: 15475778)
- 33 Kastl KG, Betz CS, Siedek V. et al. Control of bleeding following functional endoscopic sinus surgery using carboxy-methylated cellulose packing. Eur Arch Otorhinolaryngol 2009; 266: 1239-1243 DOI: 10.1007/s00405-008-0881-8. (PMID: 19082836)
- 34 Kastl KG, Betz CS, Siedek V. et al. Effect of carboxymethylcellulose nasal packing on wound healing after functional endoscopic sinus surgery. Am J Rhinol Allergy 2009; 23: 80-84 DOI: 10.2500/ajra.2009.23.3267. (PMID: 19379618)
- 35 Kastl KG, Reichert M, Scheithauer MO. et al. Patient comfort following FESS and Nasopore packing, a double blind, prospective, randomized trial. Rhinology 2014; 52: 60-65 DOI: 10.4193/Rhino13.020. (PMID: 24618630)
- 36 Leunig A, Betz CS, Siedek V. et al. CMC packing in functional endoscopic sinus surgery: does it affect patient comfort?. Rhinology 2009; 47: 36-40
- 37 Eliashar R, Gross M, Wohlgelernter J. et al. Packing in endoscopic sinus surgery: is it really required?. Otolaryngol Head Neck Surg 2006; 134: 276-279 DOI: 10.1016/j.otohns.2005.10.012.
- 38 Mo J-H, Han DH, Shin H-W. et al. No packing versus packing after endoscopic sinus surgery: pursuit of patients’ comfort after surgery. Am J Rhinol 2008; 22: 525-528 DOI: 10.2500/ajr.2008.22.3218. (PMID: 18954514)
- 39 Chandra RK, Kern RC. Advantages and disadvantages of topical packing in endoscopic sinus surgery. Current Opinion in Otolaryngology & Head and Neck Surgery 2004; 12: 21-26 DOI: 10.1097/00020840-200402000-00007. (PMID: 14712115)
- 40 Weber RK. Nasal packing after FESS--time is over?. Laryngorhinootologie 2009; 88: 379-384 DOI: 10.1055/s-0029-1220765. (PMID: 19504407)
- 41 Weber RK. Umfrage zum Einsatz von Nasentamponaden in der sinunasalen Chirurgie. Laryngo-Rhino-Otologie 2024; 103 DOI: 10.1055/a-2351-1500.
- 42 Armengot M, Hernandez R, Miguel P. et al. Effect of Total Nasal Obstruction on Nocturnal Oxygen Saturation. American Journal of Rhinology 2008; 22: 325-328 DOI: 10.2500/ajr.2008.22.3175. (PMID: 18588768)
- 43 Fitzpatrick MF, McLean H, Urton AM. et al. Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 2003; 22: 827-832 DOI: 10.1183/09031936.03.00047903. (PMID: 14621092)
- 44 Friedman M, Maley A, Kelley K. et al. Impact of Nasal Obstruction on Obstructive Sleep Apnea. Otolaryngol--head neck surg 2011; 144: 1000-1004 DOI: 10.1177/0194599811400977. (PMID: 21493302)
- 45 Johannessen N, Jensen PF, Kristensen S. et al. Nasal packing and nocturnal oxygen desaturation. Acta Otolaryngol Suppl 1992; 492: 6-8 DOI: 10.3109/00016489209136799. (PMID: 1632254)
- 46 Regli A, von Ungern-Sternberg BS, Strobel WM. et al. The impact of postoperative nasal packing on sleep-disordered breathing and nocturnal oxygen saturation in patients with obstructive sleep apnea syndrome. Anesth Analg 2006; 102: 615-620 DOI: 10.1213/01.ane.0000184814.57285.5b.
- 47 Suratt PM, Turner BL, Wilhoit SC. Effect of intranasal obstruction on breathing during sleep. Chest 1986; 90: 324-329 DOI: 10.1378/chest.90.3.324. (PMID: 3743143)
- 48 Suzuki M, Kawai K, Kawai Y. et al. Preoperative apnea-hypopnea index predicts increased postoperative intrathoracic pressure during sleep in patients who underwent endoscopic nasal surgery. Auris Nasus Larynx 2022; 49: 805-809 DOI: 10.1016/j.anl.2022.02.001.
- 49 Turhan M, Bostancı A, Akdag M. et al. A comparison of the effects of packing or transseptal suture on polysomnographic parameters in septoplasty. Eur Arch Otorhinolaryngol 2013; 270: 1339-1344 DOI: 10.1007/s00405-012-2199-9. (PMID: 23053381)
- 50 Beule AG, Weber RK, Kaftan H. et al. Übersicht: Art und Wirkung geläufiger Nasentamponaden. Laryngorhinootologie 2004; 83: 534-551 DOI: 10.1055/s-2004-825695.
- 51 Guan S, Zhao T, Ye J. et al. Influence of bilateral nasal packing on sleep oxygen saturation after general anesthesia: A prospective cohort study. Front Surg 2023; 10: 1083961 DOI: 10.3389/fsurg.2023.1083961. (PMID: 36793309)
- 52 Koudounarakis E, Chatzakis N, Papadakis I. et al. Nasal packing aspiration in a patient with Alzheimer’s disease: a rare complication. Int J Gen Med 2012; 5: 643-645 DOI: 10.2147/IJGM.S34676.
- 53 Novoa E, Junge H. Nasal packing: When a routine practice becomes a life-threatening emergency. Clin Case Rep 2020; 8: 2638-2640 DOI: 10.1002/ccr3.3241.
- 54 Smith J, Reddy E. Aspiration of Nasopore nasal packing. BMJ Case Rep 2017; 2017: bcr2017221969-bcr DOI: 10.1136/bcr-2017-221969. (PMID: 28978608)
- 55 Weber R, Hochapfel F, Leuwer R. et al. [Tampons and place holders in endonasal surgery]. HNO 2000; 48: 240-256 DOI: 10.1007/s001060050041.
- 56 Abdullah HR, Chung F. Postoperative issues: discharge criteria. Anesthesiol Clin 2014; 32: 487-493 DOI: 10.1016/j.anclin.2014.02.013. (PMID: 24882132)
- 57 Hinkelbein J, Lamperti M, Akeson J. et al. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol 2018; 35: 6-24 DOI: 10.1097/EJA.0000000000000683. (PMID: 28877145)
- 58 Hemping-Bovenkerk A, Möllmann M. Anästhesie für ambulante Eingriffe. Anästh Intensivmed 2014; 2014: 228-244
- 59 Böhmer A, Böhmer A, Defosse J. et al. Die aktualisierte Version der ASA-Klassifikation. Anästh Intensivmed 2021; 223-228 DOI: 10.19224/ai2021.223.
- 60 Hackett NJ, De Oliveira GS, Jain UK. et al. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg 2015; 18: 184-190 DOI: 10.1016/j.ijsu.2015.04.079. (PMID: 25937154)
- 61 Chung F, Chan VW, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth 1995; 7: 500-506 DOI: 10.1016/0952-8180(95)00130-a. (PMID: 8534468)
- 62 Rösslein M, Bürkle H, Walther A. et al. Position Paper: Perioperative Management of Adult Patients with Obstructive Sleep Apnea in ENT Surgery. Laryngorhinootologie 2015; 94: 516-523 DOI: 10.1055/s-0035-1549926.
- 63 Daley BJ, Cecil W, Clarke PC. et al. How slow is too slow? Correlation of operative time to complications: an analysis from the Tennessee Surgical Quality Collaborative. J Am Coll Surg 2015; 220: 550-558 DOI: 10.1016/j.jamcollsurg.2014.12.040.
- 64 Jackson TD, Wannares JJ, Lancaster RT. et al. Does speed matter? The impact of operative time on outcome in laparoscopic surgery. Surg Endosc 2011; 25: 2288-2295 DOI: 10.1007/s00464-010-1550-8.
- 65 Maggino L, Liu JB, Ecker BL. et al. Impact of Operative Time on Outcomes after Pancreatic Resection: A Risk-Adjusted Analysis Using the American College of Surgeons NSQIP Database. J Am Coll Surg 2018; 226: 844-857.e3 DOI: 10.1016/j.jamcollsurg.2018.01.004.
- 66 Pai KK, Omiunu A, Vedula S. et al. Impact of Prolonged Operative Time on Complications Following Endoscopic Sinonasal Surgery. Laryngoscope 2023; 133: 51-58 DOI: 10.1002/lary.30057. (PMID: 35174505)
- 67 Soudry E, Mohabir PK, Miglani A. et al. Outpatient endoscopic sinus surgery in cystic fibrosis patients: predictive factors for admission. Int Forum Allergy Rhinol 2014; 4: 416-421 DOI: 10.1002/alr.21285. (PMID: 24431198)
- 68 Prokopakis E, Vardouniotis A, Bachert C. et al. Rhinology Future Debates 2018, a EUFOREA Report. Rhinology 2020; 58: 384-393 DOI: 10.4193/Rhin19.455. (PMID: 32333751)
- 69 Gestuftes System von Notfallstrukturen in Krankenhäusern. https://www.g-ba.de/themen/bedarfsplanung/notfallstrukturen-krankenhaeuser/
- 70 Jakobsson JG. Recovery and discharge criteria after ambulatory anesthesia: can we improve them?. Curr Opin Anaesthesiol 2019; 32: 698-702 DOI: 10.1097/ACO.0000000000000784. (PMID: 31425193)