| Abstract | Adenotomija je kirurški zahvat odstranjenja adenoidnih vegetacija (tzv. „trećeg krajnika“) koji se najčešće provodi kod djece u prvim godinama života. Izvodi se u kratkotrajnoj općoj anesteziji, te prosječno traje nekoliko minuta. Indicirana je kod djece sa poremećajem disanja tijekom spavanja (opstruktivna apneja u snu), nazalnom opstrukcijom dišnih putova, ponavljajućom akutnom upalom srednjeg uha i kroničnim rinosinuitisom. Adenotomija se kroz jednodnevnu kirurgiju na Klinici za otorinolaringologiju i kirurgiju glave i vrata u Kliničkom bolničkom centru Rijeka provodi unatrag nekoliko godina.
Jednodnevna kirurgija je planirani prijem u zdravstvenu ustanovu s ciljem dijagnostičkog i/ili operativnog zahvata, gdje po zahvatu očekujemo brz oporavak bolesnika. Drugim riječima, radi se o kirurgiji koja ne zahtijeva duži boravak u ustanovi (primjerice tijekom noći), pa je otpust obično istog kalendarskog dana ili minimalno šest sati po učinjenom postupku. Drugi izrazi za jednodnevnu kirurgiju su ambulantna kirurgija, dnevna kirurgija ili „operacija istog dana“, a povijesno je uvedena u medicinsku praksu još sedamdesetih godina prošlog stoljeća u Sjedinjenim Američkim Državama.
Postupci u sklopu jednodnevne kirurgije mogu se obaviti u stacionarnoj ustanovi, u zasebnoj jedinici unutar bolnice (primjerice Odjel jednodnevne kirurgije), u samostalnoj jedinici (primjerice ambulantni kirurški centar) ili ponekad u liječničkoj ordinaciji. U zadnjim desetljećima bilježi se rast popularnosti ovog tipa kirurgije u mnogobrojnim zemljama i u različitim strukama što je posljedica višestrukih prednosti za bolesnika i za medicinsko osoblje. Nadalje, ovaj tip kirurgije jamči jednaku sigurnost kao i klasična bolnička kirurgija uz jednaku pojavnost komplikacija i post-kirurških hospitalizacija. Dodatno, studije pokazuju manju pojavu postoperativnih infekcija i boli kroz ovaj tip kirurgije u odnosu na zahvate izvedene kroz klasičnu hospitalizaciju.
Prednosti za bolesnika su, između ostalog, vezane uz potencijalno manji stres i anksioznost radi boravaka u bolnici, što je posebno važno u dječjoj dobi gdje prevladava strah od bolnice i medicinskog osoblja. Prednosti za medicinsko osoblje i ustanovu su lakša organizacija rada i smanjenje medicinske dokumentacije što omogućuje potencijalnu uštedu vremena koje može biti posvećeno bolesnicima s težom kliničkom slikom. Također kao prednost možemo navesti i smanjenje troškova liječenja i financijsku dobit ustanove, te niži rizik za intrahospitalne infekcije.
Unatoč mnogim prednostima jednodnevne kirurgije bitno je istaknuti i nedostatke kao što su izostanak nadzora nad predoperacijskom pripremom i postoperacijskim razdobljem, te strah bolesnika od mogućih komplikacija.
Cilj ovog istraživanja je ispitati prednosti i nedostatke izvođenja adenotomije kroz jednodnevnu kirurgiju iz perspektive roditelja i medicinskih sestara/tehničara. Dobiveni rezultati potencijalno mogu pridonijeti poboljšanju zdravstvene skrbi u našoj ustanovi. |
| Abstract (english) | Adenotomy is a surgical procedure for the removal of adenoid vegetation (also known as the "third tonsil"), most commonly performed in young children. It is done under short-term general anesthesia and typically lasts only a few minutes. The procedure is indicated for children with sleep-disordered breathing (obstructive sleep apnea), nasal airway obstruction, recurrent acute middle ear infections, and chronic rhinosinusitis. At the Clinic for Otorhinolaryngology and Head and Neck Surgery at the Clinical Hospital Center Rijeka, adenotomy has been performed through day surgery for several years.
Day surgery is a planned admission to a healthcare facility for diagnostic and/or surgical procedures, where a quick recovery is expected after the procedure. In other words, it is a type of surgery that does not require an extended stay in the facility (such as overnight), so discharge usually occurs on the same calendar day or at least six hours after the procedure. Other terms for day surgery include outpatient surgery, same-day surgery, or "same-day operation," and it was historically introduced into medical practice in the 1970s in the United States.
Procedures within day surgery can be performed in an inpatient facility, in a separate unit within a hospital (such as a Day Surgery Department), in a standalone unit (such as an outpatient surgical center), or sometimes in a doctor's office. In recent decades, there has been a growing popularity of this type of surgery in many countries and across various medical specialties, due to its multiple advantages for both patients and medical staff. Furthermore, this type of surgery ensures the same level of safety as traditional hospital surgery, with a similar incidence of complications and postoperative hospitalizations. Additionally, studies show a lower incidence of postoperative infections and pain through this type of surgery compared to procedures performed with traditional hospitalization.
The advantages for patients include, among other things, potentially lower stress and anxiety due to not staying in the hospital, which is particularly important in children, who often experience fear of hospitals and medical staff. Advantages for medical staff and the facility include easier work organization and reduced medical documentation, allowing potential time savings that can be dedicated to patients with more severe clinical conditions. Additionally, benefits include reduced treatment costs and financial gains for the facility, as well as a lower risk of hospital-acquired infections.
Despite the many advantages of day surgery, it is important to highlight the disadvantages, such as the lack of supervision during the preoperative preparation and postoperative period, and the patient's fear of possible complications.
The aim of this study is to examine the advantages and disadvantages of performing adenotomy through day surgery from the perspective of parents and nurses/technicians. The results obtained could potentially contribute to improving healthcare in our facility. |
