Trokovni centri i dnevna bolnica IVANA ZUBAC NATAA

Troškovni centri i dnevna bolnica IVANA ZUBAC NATAŠA VUJOVIĆ KONATAR TIHOMIR STRIZREP 22. 12. 2017.

ŠIFRE SLUŽBE KC Kragujevac Šifrarnik RFZO • 700 - Nuklearna medicina • Nuklearna medicina (in vivo) • Nuklearna medicina (in vitro) • Nuklearna medicina (radionuklidna terapija)

SHEMA TROŠKOVNIH CENTARA Urgentna stanja Anesteziologija i intenzivno lečenje

BUDŽET TROŠKOVNIH CENTARA Budžet za lekove i materijal Finansijska odgovornost načelnika odeljenja

Prosječno trajanje hospitalizacije (samo akutne bolnice) Source: WHO/Europe, European HFA Database, July 2016.

Podaci o bolničkim aktivnostima u Irskoj 2013 In-Patients In-patient Discharges Bed Days Used Average Length of Stay in Days Surgical In-Patients 615 211 3 332 974 5. 42 134 022 Day Cases 931 381 Surgical Day Cases 142 728 Source: http: //health. gov. ie/publications-research/statistics-by-topic/acute-hospital-activity

Klinički put dnevne kirurgije Source: Skues M. BADS Directory of Procedures, 5 th Edition. 2016.

Razlozi za ostanak preko noći Medicinske Predvidljive • Komorbiditet Kirurške • A challenging individual patient for day care Anesteziološke • Broj zaposlenika - vještine Socijalne • Nedostatak kućne njege Source: British Association of Day Surgery (BADS) Nepredvidljive • Komplikacije (kardiovaskularne, respiratorne) • Bol • Krvarenje • Postoperativna glavobolja i povraćanje • Somnolencija

Holecistektomija Grupa Naziv Broj pacijenata H 07 A Otvorena holecistektomija sa zatvorenim ispitivanjem prohodnosti ductus choledocus-a ili sa vrlo teškim KK H 07 B Otvorena holecistektomija bez zatvorenih ispitivanja prohodnosti ductus choledocus-a ili bez vrlo teških KK H 08 A Laparoskopska holecistektomija sa zatvorenim ispitivanjem prohodnosti ductus choledocus-a ili sa vrlo teškim i teškim KK H 08 B Laparoskopska holecistektomija bez zatvorenih ispitivanja prohodnosti ductus choledocus-a bez vrlo teških i teških KK Ukupno 20, 1% 5 Broj Prosečno dana trajanje (total) hospitalizacije 75 15, 0 26 279 10, 7 22 111 5, 0 101 345 3, 4 154 810 5, 3

Breast surgery Grupa Naziv J 07 Z Manje procedure kod bolesti dojke Broj Prosečno Broj dana trajanje pacijenata (total) hospitalizacije 106 295 2, 8

Katarakta Grupa Naziv C 16 Z Procedure na sočivu Country Australia Austria Belgium Canada Czech Republic Denmark Estonia Finland France Germany Hungary Ireland Israel % 96. 6 71. 5 95. 4 99. 7 95. 2 98. 4 99. 2 98. 6 88. 9 81. 3 50. 3 93. 4 92. 0 Country Italy Korea Luxembourg Mexico New Zealand Portugal Slovak Republic Slovenia Spain Sweden United Kingdom Lithuania Source: OECD Health Statistics 2017 % 96. 3 91. 8 73. 7 63. 8 95. 6 30. 9 95. 8 58. 8 97. 6 97. 9 98. 2 98. 5 41. 0 Broj Prosečno Broj dana trajanje pacijenata (total) hospitalizacije 232 565 2, 4

INTERNATIONAL ASSOCIATION FOR AMBULATORY SURGERY: Day Surgery Procedures E. N. T Throat: Surgery of adenoids and tonsillectomy Ear Surgery: Procedures with a trans-meatal approach such as placement of grommets or myringoplasty. Even some procedures with a transmastoidal approach are being performed as a day case. Nose: Almost all nasal procedures (endoscopic sinus surgery and nose reconstruction) can be performed on an ambulatory basis. GENERAL SURGERY Hernia surgery. Proctological surgery: 90% of all anal procedures Periproctal abscess incisions Proctological procedures for overnight stay (pain relief and wound control): High fistulas, surgical excision for grade IV haemorrhoids (Eisenhammer operation) Laparoscopic cholecystectomy Thyroid surgery: Hemi-thyroidectomy for nodules with a risk of carcinoma. At least 6 hours of post-operative ORAL AND MAXILLOFACIAL SURGERY recovery time is required. extraction of carious teeth in children, removal of OPHTHALMIC SURGERY impacted teeth, surgical exposure of impacted canines, cyst enucleation of large dentigenous Cataract surgery cysts, follicular cysts or keratocysts, Oculoplastic surgery, squint surgery, glaucoma, marsupialisation of mucous retention cysts in the dacryocystorhinostomia, refractive surgery floor of mouth, excision of the sublingual salivary gland, auto-transplantation of premolars and molars, dental implantology BREAST SURGERY Benign lesions: removal of cysts, fibroadenomas, biopsies of palpable/non-palpable lesions, duct excision, correction of gynaecomastia Malignant lesions: operations on day surgery basis for breast cancer are increasing due to the advent of sentinel lymph node biopsy replacing axillary lymph node dissection for primary breast cancer GYNAECOLOGY Diagnostic hysteroscopy, operative hysteroscopy for lesions protruding into the uterine cavity (fibroids), endometrial ablation by hysteroscopy and resectoscope uterine fibroid embolization using angiography, female sterilisation, diagnostic laparoscopy, Hydrolaparoscopy. Operative laparoscopy for ectopic pregnancy, removal of small and benign cysts of the ovary, hysterectomy, myomectomy and prolapse surgery.

INTERNATIONAL ASSOCIATION FOR AMBULATORY SURGERY: Day Surgery Procedures (cont. ) Foot: hallux valgus surgery, resection arthroplasty or Knee arthrodesis for hammer toe deformities knee arthroscopy (diagnostic), arthroscopic treatment of minor lesions, arthroscopic removal of Ankle arthroscopic treatment of minor lesions (e. g. free osteosynthesis material, arthroscopic anterior cartilage bodies, synovial biopsy cruciate ligament reconstruction (lateral or syndesmosis) Shoulder removal of osteosynthesis material arthroscopy and examination under general Spine anaesthesia, arthroscopic and mini-open acromioplasty, resection of the lateral part of the removal of osteosynthesis material, microdiscectomy for the treatment of a herniated clavicle, arthroscopic joint stabilization intervertebral disc Elbow Hip arthroscopy and examination under general removal of osteosynthesis material anaesthesia, arthroscopic treatment of minor ORTHOPAEDIC SURGERY lesions, extensor tendon release for treatment of tennis elbow , ulnar nerve transposition, removal of UROLOGY screws and plates and/or cerclages General urological procedures: Wrist/hand Vasectomy, hydrocelectomy, varicocelectomy, arthroscopic treatment of minor lesions, carpal vasectomy reversal, circumcision tunnel release, arthroplasty of CMC I joint for Minimally invasive procedures osteoarthritis, finger joint surgery for rheumatoid transurethral resection of bladder tumours, arthritis, Dupuytren’s contracture ureteroscopic interventions for ureteric stones, ESWL for stone treatment. PAEDIATRIC SURGERY inguinal hernia and hydrocoele, umbilical hernia, orchidopexy, circumcision, skin lesions dermoid cysts. PLASTIC SURGERY Wrist/Hand surgery: the same procedures in orthopaedics are performed by plastic surgeons Cosmetic surgery: blepharoplasty , breast augmentation, face lift, abdominoplasty with and without liposuction (with drains to be removed next morning), reconstruction operations (Z-plasty, V-Y plasty) VASCULAR SURGERY varicose veins (surgical, endovenous obliteration by radiofrequency, laser), subfacial endoscopic division (SEPS) for resection of incompetent perforating veins, thoracic sympathectomy (treatment of hyperhidrosis or Raynaud’s disease), endovascular procedures like carotid artery stenting

Potencijalne uštede Grupa B 05 Z C 11 Z C 15 A C 16 Z D 11 Z D 12 Z E 42 A E 42 B E 42 C G 07 B G 10 A G 10 B G 11 Z G 46 A G 46 B G 47 C G 48 A G 48 B G 48 C H 07 A H 07 B H 08 A H 08 B I 24 Z I 25 A I 25 B I 30 Z J 07 Z J 09 Z J 10 Z N 07 Z N 08 Z N 09 Z N 10 Z N 11 Z Broj pacijenata Hirurški zahvat na karpalnom tunelu (dekompresija n. medianusa) 9 Procedure na očnom kapku 4 Glaukom i složene procedure kod katarakte 5 Procedure na sočivu 232 Tonzilektomija i/ili adenoidektomija 160 Ostale procedure na uhu, grlu, nosu i usnoj duplji 29 Bronhoskopija, sa vrlo teškim KK 10 Bronhoskopija, bez vrlo teških KK 20 Bronhoskopija, isti dan 20 Apendektomija bez maligniteta ili peritonitisa bez vrlo teških ili teških KK 70 Procedure kod hernije, sa KK 47 Procedure kod hernije, bez KK 208 Procedure na anusu i stome 30 Složena gastroskopija, sa vrlo teškim KK 4 Složena gastroskopija, bez vrlo teških KK 27 Ostale procedure gastroskopije, istog dana 4 Kolonoskopija, sa vrlo teškim ili teškim KK 3 Kolonoskopija, bez vrlo teških ili teških KK 38 Kolonoskopija, istog dana 73 Otvorena holecistektomija sa zatvorenim ispitivanjem prohodnosti ductus choledocus-a ili sa vrlo teškim KK 5 Otvorena holecistektomija bez zatvorenih ispitivanja prohodnosti ductus choledocus-a ili bez vrlo teških KK 26 Laparoskopska holecistektomija sa zatvorenim ispitivanjem prohodnosti ductus choledocus-a ili sa vrlo teškim i teškim KK 22 Laparoskopska holecistektomija bez zatvorenih ispitivanja prohodnosti ductus choledocus-a bez vrlo teških i teških KK 101 Artroskopija 19 Dijagnostičke procedure (uključujući i biopsiju) na kostima i zglobovima, sa KK 3 Dijagnostičke procedure (uključujući i biopsiju) na kostima i zglobovima, bez KK 12 Procedure na šaci 68 Manje procedure kod bolesti dojke 106 Perianalne i pilonidalne procedure 27 Procedure plastične hirurgije na koži, potkožnom tkivu i dojci 20 Ostale procedure na materici i adneksama zbog nemalignih uzroka 138 Endoskopske i laparoskopske procedure na ženskom reproduktivnom sistemu 4 Konizacija, postupci na vagini, cerviksu (grliću materice) i vulvi (stidnici) 362 Dijagnostička kiretaža ili dijagnostička histeroskopija 202 Ostale operativne procedure na ženskom reproduktivnom sistemu 10 Ukupno 2. 118 Naziv Broj dana (total) 16 4 21 565 532 163 173 199 - 343 251 735 204 54 186 - 13 226 - 75 279 111 345 137 61 122 350 295 71 106 536 11 754 169 50 7. 157 141 godina! 60% pacijenata tretirano na dnevnoj osnovi -51. 530 dana boravka u bolnici

THE FUTURE DEPENDS UPON THE DECISIONS MADE TODAY “Will we look into the eyes of our children and confess that we had the opportunity, but lacked the courage? ” "Thank you for your attention“ tihomir. strizrep@gmail. com