Ambulatory surgery has been developed continuously in developed countries for the last two decades due to the shortened times for waiting and hospitalization, reduced costs and risks of transmission, improved arrangement of medical resources, and enhanced recovery results for patients. It has been applied to more than 80% of all surgeries . However, ambulatory surgery has been insufficiently practiced in China. Within oral and maxillofacial surgery, there are a wide variety of diseases treatable by ambulatory surgery, including extraction of impacted teeth, alveolar surgery, decompression of mandibular odontogenic cysts and so on. Therefore, ambulatory surgery can greatly contribute to oral and maxillofacial surgery. To promote and improve its use, it is necessary to study the disease characteristics of relevant patients.
According to our results, 70.73% of the patients were aged between 18 and 45 years. Since patients in this age range tend to have a greater burden in terms of school or job work, convenience was a major factor in their decision-making and was addressed by ambulatory surgery. Convenience could be a crucial advantage for promoting its further broader use. We believe these patients (18-45 years old) should be categorized into a separate group in oral and maxillofacial ambulatory surgery because their health conditions and body functions are superior to those of the other age groups. Accordingly, they commonly showed better forbearance in surgery, which minimized risk. It is potentially feasible to reduce the duration of hospitalization, times of follow-up phone calls, and overall costs by optimizing the treatment procedure while maintaining the safety of the operation. According to the incidence and timing of occurrence of complications, patients can meet the requirements for discharge during postsurgical visits at 1-hour intervals (4 h after completion of surgery). The health conditions of the patients were tracked by providing medical advice and follow-up visits on days 3 and 7 after surgery.
Different from the adult group (18-45 years old), the selection of surgery types was mainly determined by guardians when younger patients (0-17 years old) were treated. These younger patients are more vulnerable to retarded neuron growth when general anesthesia is applied. As a result, they tended to delay surgery or select partial anesthesia. According to existing studies [12-14], the risk of impaired cognition was low with 1 h of general anesthesia, and it continuously decreased with age. In this study, the main diseases of most 0–6-year-old infants (and children) included ankyloglossia, supernumerary teeth, and mucous gland cysts, which did not require treatments longer than 1 h, and there were no cases with severe postsurgical complications. Therefore, it was safe to perform ambulatory surgery in infants and children. Additionally, the promotion of ambulatory surgery among teenage patients can be achieved by disseminating related concepts and knowledge about ambulatory surgery among the public, for example, information on general anesthesia.
According to our results, complications mostly occurred within the first three days after surgery, and they gradually diminished afterward. To manage and minimize such risks, physicians and nurses should make more detailed records and give medical advice accordingly, including advice on diet, medication, and physical activities. Physicians and nurses should also provide training on reporting abnormal health conditions and reminders on rehospitalization. Follow-up visits can be used to track patient health status, provide individualized guidance, and relieve anxiety after surgery. In addition, it helps to prevent and identify postsurgical complications and improve the overall safety of treatment. Our study reported 3 cases of dry socket, which mostly occurred within 2 days after surgery and had a higher incidence as the difficulty of surgery increased [15,16]. In addition, extraction of impacted teeth always caused a large area of damage, and it was difficult to differentiate its pain and dry socket by follow-up phone call. To address this problem, it is necessary to inquire whether their pain is relieved with time. If such pain lasted longer than 1 week, a reinspection is necessary for timely treatment. Although cysts of the mucous glands and benign tumors and tumor-like masses involved smaller incisions, these conditions had a high risk of reoccurrence. The time length and frequency of follow-up visits should be increased accordingly so that earlier identification and treatment can be applied in a timely manner.
Among the studied patients, 2 cases reported extraction of internal bone fixation. They recovered well after surgery without any complications or discomfort. Related surgery was relatively easy with minimum risk when imaging techniques were applied for guidance. We believe such methods can be promoted in ambulatory surgery once necessary assessments are performed by the chief physician.