It is essential for the development of modern clinical medicine to establish a professional facility and team for wound healing. There is some successful experience of constructing and running the wound healing center to be mirrored at home and abroad. The construction of the facility and team for wound healing will be promoted by guideline issuing, profession certification, and others, which would push forward the clinical treatment and basic research of wound healing.
Health Systems Agencies ; Hospitals, Special ; organization & administration ; Humans ; Patient Care Team ; organization & administration ; Reconstructive Surgical Procedures ; Wound Healing

INTRODUCTIONWe aimed to report the outcomes of inguinal hernia repair performed at Tan Tock Seng Hospital and compare them with those performed at dedicated hernia centres.

METHODSWe retrospectively analysed the medical records and telephone interviews of 520 patients who underwent inguinal hernia repair in 2010.

RESULTSThe majority of the patients were male (498 [95.8%] men vs. 22 [4.2%] women). The mean age was 59.9 ± 15.7 years. Most patients (n = 445, 85.6%) had unilateral hernias (25.8% direct, 64.3% indirect, 9.9% pantaloon). The overall recurrence rate was 3.8%, with a mean time to recurrence of 12.0 ± 8.6 months. Risk factors for recurrence included contaminated wounds (odds ratio [OR] 50.325; p = 0.004), female gender (OR 8.757; p = 0.003) and pantaloon hernias (OR 5.059; p = 0.013). Complication rates were as follows: chronic pain syndrome (1.2%), hypoaesthesia (5.2%), wound dehiscence (0.4%), infection (0.6%), haematoma/seroma (4.8%), urinary retention (1.3%) and intraoperative visceral injury (0.6%). Most procedures were open repairs (67.7%), and laparoscopic repair constituted 32.3% of all the inguinal hernia repairs. Open repairs resulted in longer operating times than laparoscopic repairs (86.6 mins vs. 71.6 mins; p < 0.001), longer hospital stays (2.7 days vs. 0.7 days; p = 0.020) and a higher incidence of post-repair hypoaesthesia (6.8% vs. 1.8%; p = 0.018). However, there were no significant differences in recurrence or other complications between open and laparoscopic repair.

CONCLUSIONA general hospital with strict protocols and teaching methodologies can achieve inguinal hernia repair outcomes comparable to those of dedicated hernia centres.

Adult ; Aged ; Aged, 80 and over ; Female ; Hernia, Inguinal ; surgery ; Herniorrhaphy ; methods ; standards ; Hospitals, General ; organization & administration ; Hospitals, Special ; organization & administration ; Humans ; Male ; Medical Records ; Middle Aged ; Recurrence ; Retrospective Studies ; Singapore ; Treatment Outcome ; Young Adult

PURPOSE: Aim of this study is to investigate the characteristics and performance of colorectal-anal specialty vs. general hospitals for South Korean inpatients with colorectal-anal diseases, and assesses the short-term designation effect of the government's specialty hospital. MATERIALS AND METHODS: Nationwide all colorectal-anal disease inpatient claims (n=292158) for 2010-2012 were used to investigate length of stay and inpatient charges for surgical and medical procedures in specialty vs. general hospitals. The patients' claim data were matched to hospital data, and multi-level linear mixed models to account for clustering of patients within hospitals were performed. RESULTS: Inpatient charges at colorectal-anal specialty hospitals were 27% greater per case and 92% greater per day than those at small general hospitals, but the average length of stay was 49% shorter. Colorectal-anal specialty hospitals had shorter length of stay and a higher inpatient charges per day for both surgical and medical procedures, but per case charges were not significantly different. A "specialty" designation effect also found that the colorectal-anal specialty hospitals may have consciously attempted to reduce their length of stay and inpatient charges. Both hospital and patient level factors had significant roles in determining length of stay and inpatient charges. CONCLUSION: Colorectal-anal specialty hospitals have shorter length of stay and higher inpatient charges per day than small general hospitals. A "specialty" designation by government influence performance and healthcare spending of hospitals as well. In order to maintain prosperous specialty hospital system, investigation into additional factors that affect performance, such as quality of care and patient satisfaction should be carried out.
Adult ; Aged ; Anus Diseases/economics/*therapy ; Colonic Diseases/economics/*therapy ; Efficiency, Organizational ; Female ; Hospital Charges/*statistics & numerical data ; Hospitals, General/organization & administration ; Hospitals, Special/organization & administration ; Humans ; Inpatients/*statistics & numerical data ; Length of Stay/economics/*statistics & numerical data ; Male ; Middle Aged ; Outcome Assessment (Health Care)/economics/methods/*statistics & numerical data ; Rectal Diseases/economics/*therapy ; Republic of Korea