• No results found

Day Surgery

N/A
N/A
Info
Download
Protected

Academic year: 2021

Share "Day Surgery"

Copied!
63
0
0

Loading.... (view fulltext now)

Download now ( 63 Page )

Full text

(1)Metha Brattwall. Day Surgery Routines, pain and recovery. Day Surgery. Routines, pain and recovery. Metha Brattwall Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg. 2010. ISBN 978-91-628-8190-0 Printed by Intellecta Infolog AB, Gothenburg.

(2) ”‘–Š‡ ‡’ƒ”–‡–‘ˆƒ‡•–Š‡•‹‘Ž‘‰›ƒ†

(3) –‡•‹˜‡ƒ”‡

(4) •–‹–—–‡‘ˆŽ‹‹ ƒŽ ‹‡ ‡• ƒŠŽ‰”‡•ƒ‹˜‡”•‹–› ‘•’‹–ƒŽ .   DaySurgery . Routines,painandrecovery    . MethaBrattwall  .    . ‘–Š‡„—”‰‡ ‡„‡”ǡʹͲͳͲ ™‡†‡.

(5) DaySurgery____________________________________________________________________________________  ‘˜‡”ǣ‹‡ǡ‹ƒ‡Ž–‡•–”ڏ                  . ToallmydaysurgeryfriendsandcoǦworkers.     ‡–Šƒ”ƒ––™ƒŽŽ

(6) ͻ͹ͺǦͻͳǦ͸ʹͺǦͺͳͻͲǦͲ Š––’ǣȀȀŠ†ŽǤŠƒ†Ž‡Ǥ‡–ȀʹͲ͹͹Ȁʹʹͻ͵͹ ”‹–‡†„›

(7) –‡ŽŽ‡ –ƒ

(8) ˆ‘Ž‘‰. . .

(9) ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴Abstract. ABSTRACT  ƒ›•—”‰‡”›‹™‡†‡‹•‹ ”‡ƒ•‹‰„‘–Š‹—„‡”•ƒ†‹–›’‡•‘ˆ’”‘ ‡†—”‡•ǤŽ•‘ ‘Ž†‡”ƒ†•‹ ‡”’ƒ–‹‡–•ƒ”‡‘ˆ–‡‹ Ž—†‡†‹†ƒ› ƒ•‡•—”‰‡”›’”‘‰”ƒ•ǡ™Š‹ Š’—–• ƒ‡š–”ƒ†‡ƒ†‘‰‘‘†’”ƒ –‹ ‡Ǥ Methods:–—†›Iǣ—‡•–‹‘ƒ‹”‡•”‡‰ƒ”†‹‰”‘—–‹‡•—•‡†‹ʹͲͲͷ™‡”‡•‡––‘ƒŽŽ†ƒ› •—”‰‡”› Ž‹‹ •‹™‡†‡Ǥ–—†‹‡•II,III,IVǣŠ‡•‡•–—†‹‡•ȋ‹͵ͷͷ’ƒ–‹‡–•Ȍ™‡”‡ †‡•‹‰‡†ƒ•’”‘•’‡ –‹˜‡ǡ—Ž–‹ ‡–”‡ǡ•‡ŽˆǦƒ••‡••‡†ˆ‘ŽŽ‘™Ǧ—’•–—†‹‡•ǡ™Š‡”‡ “—‡•–‹‘ƒ‹”‡•™‡”‡ƒ•™‡”‡†„›–Š‡’ƒ–‹‡–•’”‡‘’‡”ƒ–‹˜‡Ž›ƒ†—’–‘͸‘–Š• ƒˆ–‡”•—”‰‡”›ǤŠ”‡‡–›’‹ ƒŽ†ƒ›•—”‰‡”›’”‘ ‡†—”‡•™‡”‡ Š‘•‡Ǣ‹‰—‹ƒŽŠ‡”‹ƒ ”‡’ƒ‹”ǡƒ”–Š”‘• ‘’‹ ’”‘ ‡†—”‡•ǡ ‘•‡–‹ „”‡ƒ•–ƒ—‰‡–ƒ–‹‘Ǥ’”‡‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š ’”‘ˆ‹Ž‡™ƒ•–Š‡•–ƒ”–‹‰’‘‹–Ǥ‡š–‡†‡†ͺǦ‹–‡Ǧͷ†“—‡•–‹‘ƒ‹”‡™ƒ•—•‡†ǤŠ‡ “—‡•–‹‘•ˆ‘ —•‡†‘“—ƒŽ‹–›‘ˆŽ‹ˆ‡ƒ†‘’ƒ‹Ǥ–—†›VǣŠ‹•‹–‡”˜‡–‹‘ƒŽ’ƒ‹ •–—†›ƒˆ–‡”ŠƒŽŽ—š˜ƒŽ‰—••—”‰‡”›™ƒ•†‡•‹‰‡†ƒ•ƒ’”‘•’‡ –‹˜‡ǡ”ƒ†‘‹œ‡††‘—„Ž‡ „Ž‹†•–—†›‹ͳͲͲ’ƒ–‹‡–•Ǥ Results:

(10) •–—†›I™ƒ••Š‘™–Šƒ–ƒŠ‹‰Š†‡‰”‡‡‘ˆ•–ƒ†ƒ”†‹œƒ–‹‘‹•’”‡•‡–ƒ‘‰ ™‡†‹•Š†ƒ›•—”‰‡”›—‹–•™‹–Š’ƒ‹„‡‹‰–Š‡‘•– ‘‘’‘•–‘’‡”ƒ–‹˜‡’”‘„Ž‡Ǥ –—†›II•Š‘™‡†–Šƒ––‘„ƒ ‘—•‡„›•‘‹‰‘”•—ˆˆ‹‰†‡ ”‡ƒ•‡†’‘•–‘’‡”ƒ–‹˜‡ ƒ—•‡ƒ„—–Šƒ†‘‡ˆˆ‡ –‘’‘•–‘’‡”ƒ–‹˜‡’ƒ‹Ǥ

(11) •–—†›IIIǡ—’Žƒ‡†Š‘•’‹–ƒŽ ‘–ƒ –•™‡”‡”‡ ‘”†‡†ˆ‘”͹ͲȀ͵ͷͷ’ƒ–‹‡–•™Š‹Ž‡͵’ƒ–‹‡–•™‡”‡”‡ƒ†‹––‡†Ǥ ‘•–‘’‡”ƒ–‹˜‡’ƒ‹™ƒ•”‡’‘”–‡†‹ͶͲΨǡʹͺΨƒ†ʹͲΨ‘ˆ‹ Ž—†‡†’ƒ–‹‡–•ƒˆ–‡”ͳǡʹ ƒ†Ͷ™‡‡•”‡•’‡ –‹˜‡Ž›Ǥ”‡•‡ ‡‘ˆ’ƒ‹’”‡‘’‡”ƒ–‹˜‡Ž›™ƒ•‹†‡–‹ˆ‹‡†ƒ•–Š‡ƒ‹ ’”‡†‹ –‘”ˆ‘”’‘•–‘’‡”ƒ–‹˜‡’ƒ‹Ǥ

(12) •–—†›IV,Ž‘‰‹–—†‹ƒŽŽ› Šƒ‰‡•‹ͺǦ‹–‡Š‡ƒŽ–Š ’”‘ˆ‹Ž‡™ƒ••Š‘™–‘„‡†‹ˆˆ‡”‡–„‡–™‡‡’”‘ ‡†—”‡•†—”‹‰͸‘–Š•ˆ‘ŽŽ‘™Ǧ—’Ǥ

(13)  •–—†›V™‡•Š‘™‡†–Šƒ–‹–”‡ƒ–‹‰’‘•–‘’‡”ƒ–‹˜‡’ƒ‹ǡ‡–‘”‹ ‘š‹„™ƒ•‘”‡‡ˆˆ‡ –‹˜‡ ™‹–Šˆ‡™‡”•‹†‡‡ˆˆ‡ –•–Šƒ–”ƒƒ†‘ŽǤ Conclusions:ƒ›•—”‰‡”›ƒ•’”‡•‡–Ž›’‡”ˆ‘”‡†‹••ƒˆ‡ƒ†™‹–Š‘—–ƒŒ‘”‘”„‹†‹–›Ǥ Š‡’”‡‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š’”‘ˆ‹Ž‡‹•‹’‘”–ƒ–ˆ‘”–Š‡”‡ ‘˜‡”› ‘—”•‡Ǥƒ‹‹•–Š‡ƒ‹ ”‡’‘”–‡†’‘•–‘’‡”ƒ–‹˜‡’”‘„Ž‡ˆ‘ŽŽ‘™‡†„›‘„‹Ž‹–›’”‘„Ž‡•Ǥ‡ ‘˜‡”›‹• †‹˜‡”‰‡–ˆ‘”†‹ˆˆ‡”‡–•—”‰‡”›ƒ† ƒŽŽ•ˆ‘”†‹ˆˆ‡”‡–ˆ‘ŽŽ‘™Ǧ—’–‹‡•Ǥ

(14) –”‡ƒ–‡–‘ˆ ’ƒ‹ƒˆ–‡”ˆ‘‘–•—”‰‡”›ǡ–Š‡

(15) ‡–‘”‹ ‘š‹„‹••Š‘™–‘„‡‘”‡‡ˆˆ‹ ‹‡––Šƒ –”ƒƒ†‘Ž™‹–Š‘—–†‡Ž‡–‡”‹‘—•‡ˆˆ‡ –•‘Š‡ƒŽ‹‰Ǥ  Keywords:†ƒ›•—”‰‡”›ǡ’‘•–‘’‡”ƒ–‹˜‡’ƒ‹ǡƒƒŽ‰‡•‹ •ǡ–”ƒƒ†‘Žǡ‡–‘”‹ ‘š‹„ǡ ’‘•–‘’‡”ƒ–‹˜‡ƒ—•‡ƒƒ†˜‘‹–‹‰ȋȌǡ‹ ‘–‹‡ǡ•—ˆˆǡ”‡ ‘˜‡”›ǡǦͷ†ǡŠ‡ƒŽ–Š ’”‘ˆ‹Ž‡ǡ•‡ŽˆǦƒ••‡••‡†“—‡•–‹‘ƒ‹”‡ǡˆ‘ŽŽ‘™Ǧ—’Ǥ. . ͵.

(16) DaySurgery____________________________________________________________________________________. CONTENTS  ABSTRACT CONTENTS LISTOFPUBLICATIONS ABBREVIATIONSANDEXPLANATIONS THESISATAGLANCE INTRODUCTION. History DSversusinǦhospitalsurgery ‡‡ˆ‹–• Futureperspectives ƒ‹–”‡ƒ–‡– Therecoveryprocessandtoolstoassessrecovery ‘ŽŽ‘™Ǧ—’ ‡ƒŽ–Š’”‘ˆ‹Ž‡ Guidelines StudyIǦV. 3 4 6 7 8 9. 9 10 ͳͲ 10 ͳͲ 11 ͳͳ ͳͳ 12 12. AIMS MATERIALANDMETHODS. 13 14. STUDYSUBJECTS. 17. REVIEWofRESULTS. 19. DISCUSSION. 31. StudyI: StudyIIǦIV: StudyV: Questionnaires,EQǦ5dand8Ǧitemhealthprofile: Statistics: StudyI: StudiesIIǦIV StudyV StudyI StudyIIǦIV StudyV Summary. Hypothesisandaim BackgroundandpresentstatusofDS(studyI) ‡Ž‡ –‹‘ ”‹–‡”‹ƒ ”‡‘’‡”ƒ–‹˜‡’Žƒ‹‰ ‘—–‹‡• Š‡—‹–

(17) ˆ‘”ƒ–‹‘ǡ•ƒˆ‡–›ƒ•’‡ –• —”‰‡”›ƒ†ƒƒ‡•–Š‡•‹ƒ ‹• Šƒ”‰‡ ”‹–‡”‹ƒ ‡ƒ†‹••‹‘ —ƒŽ‹–›ƒ†•ƒˆ‡–› ‘•‹†‡”ƒ–‹‘ ‘•–‘’‡”ƒ–‹˜‡”‡•–‹–—–‹‘ StudyIIǦIIIǦIVǦV Managementofpostoperativepain  —–‡’ƒ‹ǡ“—ƒ–‹–›ƒ†• ƒŽ‡•. Ͷ . 14 14 15 16 16. 17 18 18. 19 20 28 30 31 31 ͵ͳ ͵ʹ ͵ʹ ͵͵ ͵͵ ͵͵ ͵Ͷ ͵Ͷ ͵Ͷ ͵ͷ 35 35 ͵ͷ.

(18) ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴Contents. —Ž–‹‘†ƒŽ’ƒ‹–”‡ƒ–‡– ƒ‹ƒ†‰‡†‡”†‹ˆˆ‡”‡ ‡•  —–‡’‘•–‘’‡”ƒ–‹˜‡’ƒ‹

(19) †‹˜‹†—ƒŽ”‡•’‘•‡ ”‡†‹ –‹‘‘ˆ’ƒ‹ ‘Ǧ•–‡”‘‹†ƒ–‹Ǧ‹ˆŽƒƒ–‘”›†”—‰• ’‹‘‹†• –‹Ǧ‡’‹Ž‡’–‹ †”—‰• ‘ ƒŽƒƒ‡•–Š‡–‹ • TreatmentoflongǦlastingpain ‘–‹—‘—•†‡Ž‹˜‡”›‘ˆŽ‘ ƒŽƒƒ‡•–Š‡•‹ƒ ƒŽ‰‡•‹ –”‡ƒ–‡–‘—– ‘‡ ‡”•‹•–‡–’‘•–•—”‰‹ ƒŽ’ƒ‹ ‹•ˆƒ –‘”• ”‡˜‡–‹‘‘ˆŽ‘‰ǦŽƒ•–‹‰’ƒ‹ Postoperativenauseaandvomiting ‹ ‘–‹‡—•‡ ”‘’Š›Žƒ –‹ –”‡ƒ–‡–• ‘”–‹ ‘•–‡”‘‹†• RecoveryfollowǦup ”‡‘’‡”ƒ–‹˜‡’”‘ˆ‹Ž‡ ‡ˆ‹‹–‹‘•‘ˆ”‡ ‘˜‡”› ‘ŽŽ‘™Ǧ—’‡–Š‘†• —ƒŽ‹–›‘ˆŽ‹ˆ‡ —”ƒ–‹‘‘ˆˆ‘ŽŽ‘™—’

(20) ˆ‘”ƒ–‹‘ǡ”‡ ‘˜‡”›ƒ•’‡ –• ‘•–Ǧ†‹• Šƒ”‰‡ǡ‡‡†ˆ‘”Š‡Ž’ƒ† ‘–ƒ –• ƒ–‹•ˆƒ –‹‘ Limitations Futureperspectives. ͵ͷ ͵ͷ ͵͸ ͵͸ ͵͸ ͵͹ ͵͹ ͵͹ ͵ͺ 38 ͵ͺ ͵ͺ ͵ͻ ͵ͻ ͵ͻ 40 Ͷͳ Ͷͳ Ͷͳ 41 Ͷʹ Ͷʹ Ͷ͵ Ͷ͵ ͶͶ ͶͶ ͶͶ Ͷͷ 45 46. CONCLUSIONSandIMPLICATIONS. 48. ACKNOWLEDGEMENTS REFERENCES POPULÄRVETENSKAPLIGSAMMANFATTNING STUDIESIǦV QUESTIONNAIRES . 50 51 60. Patientselectionforprophylactictreatment Optimisedpaintreatment QualitycontrolandmethodsforfollowǦup DurationoffollowǦup Patientinformation Summary. 48 48 48 48 49 49. . . ͷ.

(21) DaySurgery____________________________________________________________________________________. LISTOFPUBLICATIONS. . . Originalstudies   Š‹•–Š‡•‹•‹•„ƒ•‡†‘–Š‡ˆ‘ŽŽ‘™‹‰•–—†‹‡•ǡ™Š‹ Š™‹ŽŽ„‡”‡ˆ‡””‡†–‘‹–Š‡–‡š–„› –Š‡‹””‘ƒ—‡”ƒŽ•ǣ   

(22) Ǥ ‡‰‡”†ƒŠŽǡƒ””±Ǧ–‘„‡”‰ǡƒ™ƒŽǡ”ƒ––™ƒŽŽǡ ƒ‘„••‘ ǤŽ‹‹ ƒŽ ’”ƒ –‹ ‡ƒ†”‘—–‹‡•ˆ‘”†ƒ›•—”‰‡”›‹™‡†‡ǣ”‡•—Ž–•ˆ”‘ƒƒ–‹‘Ǧ™‹†‡•—”˜‡›Ǥ  –ƒƒ‡•–Š‡•‹‘Ž ƒ†ǤʹͲͲͺ ƒǢͷʹȋͳȌǣͳͳ͹ǦʹͶǤ 

(23)

(24) Ǥ ”ƒ––™ƒŽŽǡƒ””±–‘„‡”‰ǡƒ™ƒŽǡ‡‰‡”†ƒŠŽǡ ‘—Ž–œǡ ƒ‘„••‘ Ǥ ‘•–‘’‡”ƒ–‹˜‡‹’ƒ –‘ˆ”‡‰—Žƒ”–‘„ƒ ‘—•‡ǡ•‘‹‰‘”•—ˆˆ‹‰ǡƒ’”‘•’‡ –‹˜‡ —Ž–‹Ǧ ‡–‡”•–—†›Ǥ –ƒƒ‡•–Š‡•‹‘Ž ƒ†ǤʹͲͳͲƒ”ǢͷͶȋ͵Ȍǣ͵ʹͳǦ͹Ǥ 

(25)

(26)

(27) Ǥ ”ƒ––™ƒŽŽǡƒ””±–‘„‡”‰ǡƒ™ƒŽǡ‡‰‡”†ƒŠŽǡ ƒ‘„••‘ ǡ ‘—Ž–œǤ ‡ ‘˜‡”›ƒˆ–‡”†ƒ›•—”‰‡”›Ǣƒ’”‘•’‡ –‹˜‡“—‡•–‹‘ƒ‹”‡•—”˜‡›†—”‹‰–Š‡ˆ‹”•–͵Ͳ †ƒ›•Ǥ’—„ƒŠ‡ƒ†‘ˆ’”‹–Ǥ –ƒƒ‡•–Š‡•‹‘ŽǤ ƒ†ǤʹͲͳͲ –Ǥ 

(28) Ǥ ”ƒ––™ƒŽŽǡ–‘„‡”‰ǡƒ™ƒŽǡ‡‰‡”†ƒŠŽǡ ‘—Ž–œǡ ƒ‘„••‘ Ǥƒ–‹‡– ƒ••‡••‡†Š‡ƒŽ–Š’”‘ˆ‹Ž‡ǣƒ•‹šǦ‘–Š“—ƒŽ‹–›‘ˆŽ‹ˆ‡“—‡•–‹‘ƒ‹”‡•—”˜‡›ƒˆ–‡”†ƒ› •—”‰‡”›Ǥ ƒ† —„Ž‹  ‡ƒŽ–ŠǤʹͲͳͲ—‰Ǣ͵ͺȋ͸Ȍǣͷ͹ͶǦͻǤ  Ǥ ”ƒ––™ƒŽŽǡ—”ƒ

(29) ǡ ƒ‘„••‘ Ǥƒ‹ƒƒ‰‡‡–ƒˆ–‡”‡Ž‡ –‹˜‡ŠƒŽŽ—š˜ƒŽ‰—• •—”‰‡”›ǣƒ’”‘•’‡ –‹˜‡”ƒ†‘‹œ‡††‘—„Ž‡Ǧ„Ž‹†•–—†› ‘’ƒ”‹‰‡–‘”‹ ‘š‹„ƒ† –”ƒƒ†‘ŽǤ‡•–ŠƒŽ‰ǤʹͲͳͲ—‰ǢͳͳͳȋʹȌǣͷͶͶǦͻǤ. ͸ .

(30) ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴ Abbreviations . ABBREVIATIONSANDEXPLANATIONS  . ƒ —–‡’‘•–‘’‡”ƒ–‹˜‡’ƒ‹. . ƒ”–Š”‘• ‘’›•—”‰‡”›. . ‡”‹ ƒ•‘ ‹‡–›‘ˆƒƒ‡•–Š‡•‹‘Ž‘‰‹•–•. . ‘•‡–‹ „”‡ƒ•–ƒ—‰‡–ƒ–‹‘. ‘š‹„•. •—„ Žƒ••‘ˆ‘Ǧ•–‡”‘‹†ƒŽƒ–‹Ǧ‹ˆŽƒƒ–‹‘†”—‰. ‘šǦʹǦ‹Š‹„‹–‘”. › Ž‘Ǧ‘š›‰‡ƒ•‡‹Š‹„‹–‹‘†”—‰. . Š”‘‹ ’‘•–•—”‰‹ ƒŽ’ƒ‹. . †ƒ›•—”‰‡”›. Ǧͷ†. ‡—”‘“—ƒŽ‹–›ͷ†‹‡•‹‘•. ͷǦ ͵Ǧ„Ž‘ ‡”. ͷǦŠ›†”‘š›–”›’–ƒ‹•—„–›’‡Ǧ͵Ǧ„Ž‘ ‡”. . Š‡ƒŽ–Š”‡Žƒ–‡†“—ƒŽ‹–›‘ˆŽ‹ˆ‡. . ŠƒŽŽ—š˜ƒŽ‰—••—”‰‡”›.

(31) . ‹–‡”ƒ–‹‘ƒŽƒ••‘ ‹ƒ–‹‘‘ˆƒ„—Žƒ–‘”›•—”‰‡”›.

(32) . ‹–‡”ƒ–‹‘ƒŽƒ••‘ ‹ƒ–‹‘ˆ‘”–Š‡•–—†›‘ˆ’ƒ‹.

(33) . ‹‰—‹ƒŽŠ‡”‹ƒ”‡’ƒ‹”.

(34) ǦŠ‘•’‹–ƒŽ. ’”‘ ‡†—”‡™‹–Š’ƒ–‹‡–•–ƒ›‹‰ƒ–Š‘•’‹–ƒŽ.

(35) Ǧ’ƒ–‹‡–. ’”‘ ‡†—”‡™‹–Š’ƒ–‹‡–•–ƒ›‹‰ƒ–Š‘•’‹–ƒŽ. . —Ž–‹‘†ƒŽ’ƒ‹–”‡ƒ–‡–. . —„‡”‡‡†‡†–‘–”‡ƒ–. 

(36) . ‘Ǧ•–‡”‘‹†ƒŽƒ–‹Ǧ‹ˆŽƒƒ–‘”›†”—‰. . —‡”‹ ƒŽ”ƒ–‹‰• ƒŽ‡ˆ‘”’ƒ‹ƒ••‡••‡–. —–’ƒ–‹‡–. ’”‘ ‡†—”‡’‡”ˆ‘”‡†ƒ•†ƒ›•—”‰‡”›. . ’‘•–Ǧƒƒ‡•–Š‡•‹ƒ ƒ”‡—‹–. . ’ƒ–‹‡– ‘–”‘ŽŽ‡†ƒƒŽ‰‡•‹ƒ. . ’‘•–Ǧ‘’‡”ƒ–‹˜‡ƒ—•‡ƒ. . ’‘•–Ǧ‘’‡”ƒ–‹˜‡ƒ—•‡ƒƒ†˜‘‹–‹‰. . ’‘•–‘’‡”ƒ–‹˜‡. . ’‡”•‹•–‡–’‘•–•—”‰‹ ƒŽ’ƒ‹. ‘. “—ƒŽ‹–›‘ˆŽ‹ˆ‡. ‡ ‘˜‡”›. –Š‡’”‘ ‡••‘ˆ”‡ ‘˜‡”›ˆ”‘‹ŽŽ‡••.  

(37) . Dz•˜‡•ˆÚ”‡‹‰ˆÚ”ƒ‡•–‡•‹‘ Š‹–‡•‹˜˜¤”†dz. —ˆˆ. ‘‹•–’‘™†‡”–‘„ƒ ‘. . ˜‹•—ƒŽƒƒŽ‘‰—‡• ƒŽ‡. . ͹.

(38) DaySurgery____________________________________________________________________________________ . THESISATAGLANCE   Aim and focus. Study size 92 hospitals. Study period One year (2005). Study I. Inventory of routines in Sweden. Study II. Impact of n=390 tobacco use on PONV and pain. Until 1 week postsurgery. Study III. Recovery Readmissions Contacts Pain. n=390. Until 4 weeks after surgery. Study IV. Health profile Quality of life. n=390. Until 6 months after surgery. Study V. Choice of analgesics Coxib or Tramadol after hallux valgus. n=50 + 50 1 week 2 weeks 16 weeks. Methods Questionnaire. Results. Standardized regimes. 50% day surgery. Pain the main symptom Prospective Smoke and questionnaires snuff reduce Multi-centre PONV. Age and gender influence PONV. Pain the main Prospective questionnaires symptom. Day surgery is safe. Recovery is End-points: procedure improved specific. recovered Prospective Preoperative questionnaires profile is important. Different End-point: fully recovered follow-up times required. Etoricoxib Prospective most effective randomized and less sidedouble-blind effects. No impaired Phone and healing. visits.

(39) ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴ . Introduction. INTRODUCTION  Š‡ ‘ ‡’–‘ˆ†ƒ›•—”‰‡”›Ǣ‹Ǥ‡Ǥ–‘’‡”‹–ƒ’ƒ–‹‡––‘ƒ””‹˜‡‹–Š‡‘”‹‰ƒ†ƒˆ–‡” ƒ•—”‰‹ ƒŽ’”‘ ‡†—”‡”‡–—”Š‘‡‹–Š‡‡˜‡‹‰‹•‘–‡™Ǥ ƒ‡•‹ ‘ŽŽȋͳͺ͸ͶǦ ͳͻʹͳȌ‹• ‘•‹†‡”‡†–Š‡ˆƒ–Š‡”‘ˆ†ƒ›•—”‰‡”›Ǥ––Š‡‹ Š‹Ž†”‡ǯ• ‘•’‹–ƒŽ‹. Žƒ•‰‘™ǡŠ‡’‡”ˆ‘”‡†‡ƒ”Ž›ͻͲͲͲ’ƒ‡†‹ƒ–”‹ †ƒ›•—”‰‡”› ƒ•‡•–Šƒ–Š‡”‡’‘”–‡†‹ –Š‡”‹–‹•Š‡†‹ ƒŽ ‘—”ƒŽͳͻͲͻȋͳȌǤ—”‹‰‡˜‘Ž—–‹‘‘ˆ†ƒ›•—”‰‡”›ƒ›†‹ˆˆ‡”‡– ƒ‡•Šƒ˜‡„‡‡—•‡†ǡˆ‘”‡šƒ’Ž‡ǣ†ƒ›•—”‰‡”›ǡƒ„—Žƒ–‘”›•—”‰‡”›ǡ•ƒ‡†ƒ› •—”‰‡”›ǡʹ͵Š‘—”••—”‰‡”›ǡ‡š–‡†‡††ƒ›•—”‰‡”›ǡ‘—–Ǧ’ƒ–‹‡–•—”‰‡”›ƒ†‘ˆˆ‹ ‡Ǧ „ƒ•‡†•—”‰‡”›ǡ–‘ƒ‡ƒˆ‡™ȋʹȌǤ‰‡‡”ƒŽ–”‡†‹•”‡†— –‹‘‹–Š‡Ž‡‰–Š‘ˆŠ‘•’‹–ƒŽ •–ƒ›ȋ͵ȌǤ”ƒ†‹–‹‘ƒŽ†ƒ›•—”‰‡”›‹•ƒŽ™ƒ›•‡Ž‡ –‹˜‡•—”‰‡”›Ǥ‡”‹‘Ž‘‰›ƒ† †‡ˆ‹‹–‹‘•Šƒ˜‡„‡‡•—‰‰‡•–‡†„›–Š‡

(40) –‡”ƒ–‹‘ƒŽ••‘ ‹ƒ–‹‘‘ˆ„—Žƒ–‘”› —”‰‡”›ȋ

(41) ǡŠ––’ǣȀȀ‹ƒƒ•Ǧ‡†Ǥ ‘ȌǤ

(42) ™‡†‡ǡ†ƒ›•—”‰‡”›—•—ƒŽŽ›‡ƒ•–Šƒ– ’ƒ–‹‡–•Ž‡ƒ˜‡–Š‡Š‘•’‹–ƒŽ–Š‡•ƒ‡†ƒ›ƒ•–Š‡•—”‰‡”›ƒ†•Ž‡‡’‹–Š‡‹”‘™„‡†ƒ– Š‘‡Ǥ

(43) –Š‹•–Š‡•‹•ǡ–Š‡–‡”†ƒ›•—”‰‡”›ȋȌ™‹ŽŽ„‡—•‡†‹–Šƒ–•‡•‡Ǥ. History •–ƒ”–‡†™‹–Š•Š‘”–’”‘ ‡†—”‡•’‡”ˆ‘”‡†ƒ––Š‡•ƒ‡—‹–ƒ•–Š‡‹ǦŠ‘•’‹–ƒŽ ‘’‡”ƒ–‹‘•Ǥ

(44) –Š‡‡”ƒ‘ˆ‰‡‡”ƒŽƒƒ‡•–Š‡•‹ƒǡ‡ƒ‹‰‡–Š‡”‘” ŠŽ‘”‘ˆ‘”ǡ–Š‡•‡ ’”‘ ‡†—”‡•™‡”‡Ž‹‹–‡†–‘”‡‰‹‘ƒŽ‘”Ž‘ ƒŽƒƒ‡•–Š‡•‹ƒǤ‘•’‡ ‹ˆ‹ ’”‘ ‡†—”‡•™‡”‡ †‡•‹‰‡†ˆ‘”–Š‡ ƒ•‡•Ǥ‘–—–‹Žͳͻ͸ʹ†‹†–Š‡ˆ‹”•–•’‡ ‹ˆ‹ Š‘•’‹–ƒŽ„ƒ•‡†—‹– •–ƒ”–ƒ–ȋ‹˜‡”•‹–›‘ˆƒŽ‹ˆ‘”‹ƒƒ–‘•‰‡Ž‡•ȌǡȋͶȌǤ Š‡ˆ‹”•–—‹–•‹™‡†‡ǡ ƒŽŽ‡†—‹–•ǡ•–ƒ”–‡†‡ƒ”Ž›‹–Š‡ͳͻͺͲƲ•ǡƒŽ–Š‘—‰Šƒ› Š‘•’‹–ƒŽ••–‹ŽŽ†‘‘–Šƒ˜‡•‡’ƒ”ƒ–‡—‹–•Ǥ

(45) –Š‡•‡Š‘•’‹–ƒŽ•’ƒ–‹‡–•ƒ†‹Ǧ Š‘•’‹–ƒŽ’ƒ–‹‡–•ƒ”‡‹š‡†ǡƒ‹‰‹–†‹ˆˆ‹ —Ž––‘‘’–‹‹œ‡”‘—–‹‡•–‘•—‹– ƒ•‡•Ǥ

(46) ˆ –Š‡•ƒ‡•–ƒ†ƒ”†”‘—–‹‡•ƒ”‡—•‡†ˆ‘”„‘–Š‹ǦŠ‘—•‡ƒ†’ƒ–‹‡–•ǡ–Š‡•‡”‘—–‹‡• ™‹ŽŽ‘–„‡‘’–‹‹œ‡†ˆ‘”–Š‡’ƒ–‹‡–•Ǥ —”‹‰–Š‡Žƒ•–ʹͲǦ͵Ͳ›‡ƒ”•ǡ–Š‡ ƒ†‹ƒ˜‹ƒ†‡˜‡Ž‘’‡–‘ˆŠƒ•ˆ‘ —•‡†‘•ƒˆ‡ ”‘—–‹‡•ǡ•Š‘”–ƒ –‹‰ƒƒ‡•–Š‡•‹ƒƒ†•’‡ ‹ˆ‹ ’”‘ ‡••‡•ˆ‘”’ƒ–‹‡–•ǤŠ‡™‡†‹•Š ƒ›—”‰‡”›••‘ ‹ƒ–‹‘•–ƒ”–‡†‹ͳͻͻͻǤ

(47) –Š‹•ˆ‘”—•–ƒ†ƒ”†•ˆ‘”™‡†‹•Šƒ”‡ †‡˜‡Ž‘’‡†Ǥ .  . ͻ.

(48) DaySurgery____________________________________________________________________________________. DSversusinͲhospitalsurgery ‡••‹˜ƒ•‹˜‡•—”‰‹ ƒŽ’”‘ ‡†—”‡•ǡ‡™•Š‘”–ƒ –‹‰ƒƒ‡•–Š‡•‹ƒƒ‰‡–•ƒ†„‡––‡” ƒƒ‰‡‡–‘ˆ’‘•–‘’‡”ƒ–‹˜‡’ƒ‹ƒ†ƒ—•‡ƒŠƒ˜‡ˆƒ ‹Ž‹–ƒ–‡†–Š‡‹ ”‡ƒ•‡‹Ǥ ƒŽ›•‹•„›˜ƒ†‡”‡˜‡”‡–ƒŽƒ†‘•‡‡–ƒŽ•Š‘™‡†–‘„‡ ‘•–Ǧ‡ˆˆ‡ –‹˜‡ǡƒ•–Š‡ •Š‘”–Š‘•’‹–ƒŽ‹œƒ–‹‘–‹‡ƒ††‡ ”‡ƒ•‡†•–ƒˆˆ”‡†— ‡ ‘•–•ȋͷǦ͸ȌǤ ‘™‡˜‡”ǡ’—–• ‹ ”‡ƒ•‡††‡ƒ†•‘’ƒ–‹‡–•‡Ž‡ –‹‘ƒ†‘’–‹‹œ‡†”‘—–‹‡•ǡ‹‘”†‡”‘––‘ ‡‰ƒ–‹˜‡Ž›ƒˆˆ‡ –’ƒ–‹‡–•ƒˆ‡–›Ǥ”‡˜‹‘—•‹˜‡•–‹‰ƒ–‹‘•Šƒ˜‡‘–ˆ‘—† ‘’Ž‹ ƒ–‹‘ ”ƒ–‡•–‘„‡Š‹‰Š‡”ˆ‘” ‘’ƒ”‡†–‘‹ǦŠ‘•’‹–ƒŽ•—”‰‡”›ǡ‹ˆ’ƒ–‹‡–•ƒ”‡ ƒ”‡ˆ—ŽŽ› •‡Ž‡ –‡†ȋ͹ǦͺȌǤƒ”‡ˆ—Ž’”‡‘’‡”ƒ–‹˜‡‡˜ƒŽ—ƒ–‹‘ƒ†’ƒ–‹‡–‹ˆ‘”ƒ–‹‘ƒ”‡ ˆ—†ƒ‡–ƒŽˆ‘”‹‹‹œ‹‰†‡˜‹ƒ–‹‘•ˆ”‘‘’–‹ƒŽ ‘—”•‡ƒˆ–‡”Ǥ ‡ˆ‹ ‹–•‹’”‘ ‡••‡•ƒ”‡ ƒ ‡ŽŽƒ–‹‘ǡ‘Ǧ’Žƒ‡†Š‘•’‹–ƒŽƒ†‹••‹‘‘”‡‡†ˆ‘” ”‡ƒ†‹••‹‘™Š‹ ŠƒŽŽƒ”‡‡‰ƒ–‹˜‡ˆ‘”“—ƒŽ‹–›ǡ•ƒˆ‡–›ƒ† ‘•–•Ǥ‡ƒ†‹••‹‘”ƒ–‡•‘” ‘–Š‡”’‘•–‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š ƒ”‡ ‘–ƒ –•ƒ”‡‘”ƒŽŽ›Ž‘™ƒ†‘–Š‹‰Š‡”–Šƒˆ‘” ’ƒ–‹‡–•†‹• Šƒ”‰‡†ƒˆ–‡”‹Ǧ’ƒ–‹‡–•—”‰‡”›ȋͻȌǤ—”‹‰–Š‡”‡ ‘˜‡”›’‡”‹‘†ƒ–Š‘‡ǡ –Š‡’ƒ–‹‡–•ƒ›‡‡†–‘ ‘–ƒ ––Š‡—‹–ǡ‰‡‡”ƒŽ’”ƒ –‹–‹‘‡”‘”‘–Š‡”Š‡ƒŽ–Š ƒ”‡ ’”‘˜‹†‡”•Ǥ

(49) ˆ‘”ƒ–‹‘”‡‰ƒ”†‹‰™Š‘–‘ ‘–ƒ –‹ˆ‡‡†‡†Šƒ•–‘„‡•—’’Ž‹‡†„‡ˆ‘”‡ †‹• Šƒ”‰‡ȋͳͲȌǤ Benefits Š‡”‡ƒ”‡ƒŽ•‘„‡‡ˆ‹–•ˆ‘”–Š‡’ƒ–‹‡–••— Šƒ•ˆ‡™‡”‹ˆ‡ –‹‘•ǡ”‡†— ‡†”‹•ˆ‘” –Š”‘„‘Ǧ‡„‘Ž‹•†—‡–‘–Š‡‡ƒ”Ž›ƒ„—Žƒ–‹‘ƒ†Ž‡••ƒš‹‡–›ƒ† ‘ˆ—•‹‘‹–Š‡ ‡Ž†‡”Ž›ȋͳͳȌǤ. Futureperspectives ‹•‹ ”‡ƒ•‹‰„‘–Š‹™‡†‡ƒ†‹–Š‡”‡•–‘ˆ–Š‡™‘”Ž†Ǥ

(50) ™‡†‡‹ʹͲͲͺǡ ƒ„‘—–͸ͲΨ‘ˆƒŽŽ•—”‰‡”›™ƒ•’‡”ˆ‘”‡†ƒ•ƒ ‘”†‹‰–‘•–ƒ–‹•–‹ •ˆ”‘–Š‡ ™‡†‹•Šƒ–‹‘ƒŽ‘ƒ”†‘ˆ ‡ƒŽ–Šƒ†‡Žˆƒ”‡ȋ‘ ‹ƒŽ•–›”‡Ž•‡ǡ™™™Ǥ•‘•Ǥ•‡ȌǤ ˆ—”–Š‡”‡š’ƒ•‹‘‹ ƒ„‡‡š’‡ –‡†ǡ–Š‡’‘–‡–‹ƒŽ‹•‡•–‹ƒ–‡†–‘„‡ƒ•Š‹‰Šƒ• ͹ͷΨ‘ˆƒŽŽ•—”‰‹ ƒŽ’”‘ ‡†—”‡•ȋͳʹȌǤŠ‹•‹ ”‡ƒ•‡‹”‡“—‹”‡•™‡ŽŽ ‘‘”†‹ƒ–‡† ’”‘ ‡••„ƒ•‡†”‘—–‹‡•ƒ†–”ƒ‹‡†•–ƒˆˆˆ‘ —•‹‰‘’ƒ–‹‡–•ƒˆ‡–›ǡ™Š‹Ž‡•–‹ŽŽƒ‹‰ ‹–’‘••‹„Ž‡ˆ‘”–Š‡’ƒ–‹‡––‘„‡†‹• Šƒ”‰‡†–Š‡•ƒ‡†ƒ›ƒ••—”‰‡”›Ǥ•’‡ –•Ž‹‡ ‰‡‡”ƒŽŠ‡ƒŽ–Šǡ†ƒ‹Ž›Ž‹˜‹‰ǡ’•› Š‘•‘ ‹ƒŽ•–ƒ–—•ƒ†–›’‡‘ˆ•—”‰‡”›Šƒ˜‡–‘„‡ ƒ††”‡••‡†’”‹‘”–‘†‡ ‹•‹‘‘ˆ‹•–‡ƒ†‘ˆ‹ǦŠ‘•’‹–ƒŽ•—”‰‡”›Ǥ ‘”•ƒˆ‡–›”‡ƒ•‘•ǡ –Š‡’ƒ–‹‡–—•–„‡ƒ„Ž‡–‘ ‘’‡™‹–Š–”ƒ•’‘”–ǡ„‡ƒ„Ž‡–‘•–ƒ›ƒ–Š‘‡ƒ†Šƒ˜‡–‘ Šƒ˜‡ƒƒ†—Ž––‘Š‡Ž’‹ˆ‡‡†‡†–Š‡ˆ‹”•–‹‰Š–ƒˆ–‡”•—”‰‡”›ȋͳ͵ȌǤ

(51) ‘”†‡”–‘•ƒˆ‡Ž› –”ƒ•ˆ‘”‹ǦŠ‘—•‡ ƒ•‡•–‘ ƒ•‡•‹–‹•‡ ‡••ƒ”›–‘†‡˜‡Ž‘’ƒ†‡•–ƒ„Ž‹•ŠŠ‹‰Š “—ƒŽ‹–›ˆƒ ‹Ž‹–‹‡•ƒ†”‘—–‹‡•–Šƒ–ƒ”‡•—„Œ‡ ––‘ ‘–‹—‘—•ˆ‘ŽŽ‘™—’’”‘ ‡†—”‡•Ǥ Paintreatment Ž”‡ƒ†› ‹’’‘ ”ƒ–‡•ƒ†‡• ƒ”–‡•†‡• ”‹„‡†’ƒ‹–”‡ƒ–‡–ƒ•‹’‘”–ƒ–Ǥ

(52) •’‹–‡‘ˆ ƒŽŽ‡ˆˆ‘”–•‹–Š‡ˆ‹‡Ž†‘ˆ’ƒ‹ ‘–”‘Žǡ–Š‡’ƒ–‹‡–••–‹ŽŽ•—ˆˆ‡”ˆ”‘•‡˜‡”‡’ƒ‹ƒˆ–‡” •—”‰‡”›Ǥ‘Ž‹‡–ƒŽ•–—†‹‡†–Š‡‡ˆˆ‡ –‹˜‡‡••‘ˆ’ƒ‹ ‘–”‘Žƒˆ–‡”•—”‰‡”›ƒ†ˆ‘—† –Šƒ–ƒ›’ƒ–‹‡–•Šƒ˜‡‘†‡”ƒ–‡‘”•‡˜‡”‡’‘•–‘’‡”ƒ–‹˜‡’ƒ‹ȋͳͶȌǤŠ‡ ͳͲ .

(53) ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴ . Introduction.

(54) –‡”ƒ–‹‘ƒŽ••‘ ‹ƒ–‹‘ˆ‘”–—†›‘ˆƒ‹ȋ

(55) Ȍ‹ƒˆ‘ŽŽ‘™Ǧ—’‘ˆ–Š‹•™‘”ǡ ‘„•‡”˜‡†‘‹’”‘˜‡‡–ͷ›‡ƒ”•Žƒ–‡”ǤŠ‡”‡ ‡–Ž›†‡˜‡Ž‘’‡†—Ž–‹‘†ƒŽ ƒ’’”‘ƒ Š‘ˆ’ƒ‹ ‘–”‘Ž‹•ƒ‡–Š‘†‘ˆ ‘„‹‹‰†‹ˆˆ‡”‡–ƒƒŽ‰‡•‹ •‹‘”†‡”–‘ ‹’”‘˜‡’ƒ‹–”‡ƒ–‡–ƒ†–‘”‡†— ‡‹–••‹†‡‡ˆˆ‡ –•ȋͳͷȌǤ‡–Š‘†•‘ˆ„‡––‡”’ƒ‹ ‘–”‘Ž†—”‹‰–Š‡™Š‘Ž‡’‘•–‘’‡”ƒ–‹˜‡’‡”‹‘†ƒ†Ž‡••‹˜ƒ•‹˜‡•—”‰‹ ƒŽ’”‘ ‡†—”‡• ƒ”‡–Š‡ƒŒ‘”’ƒ”–•‘ˆˆ—–—”‡†‡˜‡Ž‘’‡–‘ˆǤ. Therecoveryprocessandtoolstoassessrecovery Š‡”‡ ‘˜‡”›’”‘ ‡••ƒ›„‡•‡’ƒ”ƒ–‡†‹–‘†‹ˆˆ‡”‡–•–ƒ‰‡•ǣ x. x x x. Early”‡ ‘˜‡”›‡ƒ•”‡•–‘”ƒ–‹‘‘ˆ˜‹–ƒŽˆ— –‹‘•ǡ™Š‹ Š ƒ„‡ƒ••‡••‡†„› –Š‡Ž†”‡–‡• ‘”‡ȋ˜‹–ƒŽ•‹‰•ǡƒ„—Žƒ–‹‘ƒ†‡–ƒŽ•–ƒ–—•ǡ’ƒ‹ƒ† ’‘•–‘’‡”ƒ–‹˜‡ƒ—•‡ƒƒ†˜‘‹–‹‰ȋȌǡ•—”‰‹ ƒŽ„Ž‡‡†‹‰ǡ‹–ƒ‡ƒ† ‘—–’—–Ȍȋͳ͸ȌǤ Fasttrack‹•™Š‡–Š‡’ƒ–‹‡–„›Ǧ’ƒ••‡•–Š‡’‘•–Ǧƒƒ‡•–Š‡•‹ƒ ƒ”‡—‹– ȋȌƒˆ–‡”•Š‘”–ƒ –‹‰ƒƒ‡•–Š‡•‹ƒƒ†‰‘‡•†‹”‡ ––‘–Š‡”‡ ‘˜‡”›’Šƒ•‡ ȋͳ͹ȌǤ Dischargeeligibility‹•™Š‡–Š‡’ƒ–‹‡–‹•ƒ„Ž‡–‘†”‹ǡ˜‘‹†ƒ†ƒ„—Žƒ–‡ ™‹–Š‘—–ƒŒ‘”’ƒ‹ƒ†Ȁ‘”ƒ—•‡ƒǡȋͳͺǦʹͲȌǤ Streetfit‡ƒ•–Šƒ––Š‡’ƒ–‹‡– ƒ”‡•—‡‘”ƒŽƒ –‹˜‹–›™‹–Š‘—–ƒ› ’”‘ ‡†—”‡”‡Žƒ–‡†‹–‡”ˆ‡”‡ ‡•ȋʹͳȌǤ. FollowͲup ”‡˜‹‘—••–—†‹‡•‘ˆ’‘•–‘’‡”ƒ–‹˜‡‡ˆˆ‡ –•‘ˆ•—”‰‡”›‘†ƒ‹Ž›Ž‹˜‹‰Šƒ˜‡†‡• ”‹„‡†–Š‡ ”‡ ‘˜‡”›’”‘ ‡••ȋʹͳȌǤŠ‡•‡”‡•—Ž–•Šƒ˜‡Ž‡†—•–‘„‡Ž‹‡˜‡–Šƒ–•–—†‹‡•‘ˆ ’‘•–‘’‡”ƒ–‹˜‡”‡ ‘˜‡”›ƒˆ–‡”ƒ›„‡‡ˆ‹–ˆ”‘ƒŽ‘‰‡”’‡”•’‡ –‹˜‡–Šƒ–Š‡ ‹‡†‹ƒ–‡’‘•–‘’‡”ƒ–‹˜‡’‡”‹‘†Ǥ•ƒƒ––‡”‘ˆˆƒ –ǡ–Š‡

(56) –‡”ƒ–‹‘ƒŽ••‘ ‹ƒ–‹‘‘ˆ „—Žƒ–‘”›—”‰‡”›ȋ

(57) ȌǡŠƒ˜‡”‡ ‡–Ž›•—‰‰‡•–‡†–Šƒ–ˆ‘ŽŽ‘™Ǧ—’‘ˆ”‡ ‘˜‡”›ƒˆ–‡” •Š‘—Ž† ‘˜‡”͵Ͳ†ƒ›•ƒˆ–‡”•—”‰‡”› ȋŠ––’ǣȀȀ™™™Ǥƒ•ƒŠ“Ǥ‘”‰Ȁ’—„Ž‹ ƒ–‹‘†‡”˜‹ ‡•Ȁ‘—– ‘‡‹†‹ ƒ–‘”•Ǥ’†ˆȌǤ•‹• ’‡”ˆ‘”‡†—’‘˜ƒ”‹‘—•’ƒ–‹‡–‰”‘—’•ƒ†‹ Ž—†‡•ƒ™‹†‡˜ƒ”‹‡–›‘ˆ•—”‰‹ ƒŽ ’”‘ ‡†—”‡•‹–•‡‡•”‡ƒ•‘ƒ„Ž‡–Šƒ––Š‡–‹‡–‘ˆ—ŽŽ”‡•–‹–—–‹‘ƒˆ–‡”ƒ›„‡ ˜ƒ”‹ƒ„Ž‡™‹–Š‹™‹†‡–‹‡Ž‹‹–•Ǥ Healthprofile Š‡ˆƒ –‘”•‹ˆŽ—‡ ‹‰–Š‡”‡ ‘˜‡”›’”‘ ‡••ƒ”‡‹ ‘’Ž‡–‡Ž›‹˜‡•–‹‰ƒ–‡†Ǥ• ‡–‹‘‡†ƒ„‘˜‡ǡ‹†‹˜‹†—ƒŽ’ƒ–‹‡–ˆƒ –‘”•ƒ•™‡ŽŽƒ•ˆƒ –‘”•„‡‹‰’ƒ”–‘ˆ–Š‡ •—”‰‹ ƒŽ’”‘ ‡†—”‡ƒ›‹ˆŽ—‡ ‡”‡ ‘˜‡”›Ǥ”‡•—ƒ„Ž›–Š‡’‘•–‘’‡”ƒ–‹˜‡ ‘—”•‡ ƒ›„‡”‡Žƒ–‡†–‘–Š‡’”‡‘’‡”ƒ–‹˜‡•–ƒ–—•‘ˆ–Š‡’ƒ–‹‡–ǡƒ‹••—‡‹˜‡•–‹‰ƒ–‡†‹–Š‹• •–—†›Ǥ”‡ˆ‡”ƒ„Ž›–Š‹• ‘—Ž†„‡ƒ Š‹‡˜‡†„›”‡Žƒ–‹‰–‘ƒ•–ƒ†ƒ”†‹•‡†’”‡‘’‡”ƒ–‹˜‡ Š‡ƒŽ–Š’”‘ˆ‹Ž‡•—„‹––‡†„›–Š‡’ƒ–‹‡–ǤŠ‡”‡Ž‡˜ƒ ‡‘ˆ•— ŠƒŠ‡ƒŽ–Š’”‘ˆ‹Ž‡•Š‘—Ž† „‡‡˜ƒŽ—ƒ–‡†ˆ‘”•‡˜‡”ƒŽ†‹ˆˆ‡”‡–•—”‰‹ ƒŽ’”‘ ‡†—”‡•‹‘”†‡”–‘‹˜‡•–‹‰ƒ–‡™Š‡–Š‡” ƒ”‡Ž‹ƒ„Ž‡’”‡†‹ –‹‘‘ˆ–Š‡’‘•–‘’‡”ƒ–‹˜‡’”‘ ‡•• ‘—Ž†„‡ƒ†‡Ǥ. . ͳͳ.

(58) DaySurgery____________________________________________________________________________________. Guidelines ƒ’‹†”‡–—”‘ˆ˜‹–ƒŽˆ— –‹‘•ǡ”‡•—’–‹‘‘ˆƒ –‹˜‹–‹‡•‘ˆ†ƒ‹Ž›Ž‹˜‹‰ƒ†’ƒ–‹‡– •ƒ–‹•ˆƒ –‹‘ƒ”‡‹’‘”–ƒ–ˆ‘”–Š‡‹’”‘˜‡‡–•‹ ƒ”‡ǤŠ‡’‘•–Ǧ†‹• Šƒ”‰‡ ”‡ ‘˜‡”›’”‘ ‡••‹•‘–™‡ŽŽ†‡ˆ‹‡†‘”•–—†‹‡†Ǥ’’”‘’”‹ƒ–‡’”‘ ‡†—”‡•’‡ ‹ˆ‹  ’”‘‰”ƒ•ƒ††”‡••‹‰•— Š“—‡•–‹‘•ƒ•Š‘™ǡ™Š‡ƒ†ˆ‘”Š‘™Ž‘‰–Š‡’ƒ–‹‡–• •Š‘—Ž†„‡ˆ‘ŽŽ‘™‡†Ǧ—’ƒ”‡‘–†‡˜‡Ž‘’‡†‘” ‘‘”†‹ƒ–‡†Ǥ™‡†‹•Š”‘—–‹‡••— Šƒ• •‡ŽˆǦƒ••‡••‡†Š‡ƒŽ–Š Š‡ —’Ž‹•–•ǡ’”‡‘’‡”ƒ–‹˜‡”‘—–‹‡•ǡ’”‘’Š›Žƒ –‹ ’ƒ‹ –”‡ƒ–‡–ǡƒ†ˆ‘ŽŽ‘™Ǧ—’’”‘‰”ƒ•ƒ”‡‘– ‘‘”†‹ƒ–‡†ǤŠ‡ƒ„‹–‹‘–‘ˆ—”–Š‡” ‹ ”‡ƒ•‡“—ƒŽ‹–›‹™‡†‹•Š™‘—Ž†’”‘„ƒ„Ž›„‡‡ˆ‹–ˆ”‘‘”‡ ‘‘’‡”ƒ–‹‘ǡ•— Š ƒ•Ž‘ ƒŽŽ›‰ƒ‹‡†‡š’‡”‹‡ ‡• ‘—Ž†„‡—–‹Ž‹œ‡†ƒ† ‘‘”†‹ƒ–‡†‹–Š‡†‡˜‡Ž‘’‡–‘ˆ ƒ–‹‘ƒŽ‰—‹†‡Ž‹‡•Ǥ. StudyIͲV

(59) ‘”†‡”–‘‡˜ƒŽ—ƒ–‡–Š‡’”‡•‡–•–ƒ–—•‘ˆ‹™‡†‡ǡƒ“—‡•–‹‘ƒ‹”‡•–—†›ǡ ‹˜‘Ž˜‹‰ƒŽŽ™‡†‹•ŠŠ‘•’‹–ƒŽǡ™ƒ•†‡•‹‰‡†ǤŠ‡“—‡•–‹‘•‹–Š‹••–—†› ‘˜‡”‡† ˜‘Ž—‡•ǡ”‘—–‹‡•ǡƒ†ˆ‘ŽŽ‘™—’‘ˆ–Š‡postoperative course after DS (study I). ‡ ’—”’‘•‡‘ˆ–Š‹•–Š‡•‹•™ƒ•–‘‹˜‡•–‹‰ƒ–‡–Š‡ Šƒ”ƒ –‡”‹•–‹ •‘ˆ†‹ˆˆ‡”‡–’”‘ ‡†—”‡•ǡ „›‹˜‡•–‹‰ƒ–‹‰–Š‡’‘•–‘’‡”ƒ–‹˜‡ ‘—”•‡ƒˆ–‡”ǡ™‹–Š•’‡ ‹ƒŽ”‡‰ƒ”†–‘–‹‡‘ˆ ”‡ ‘˜‡”›ƒ†’”‘„Ž‡•ƒ”‹•‹‰†—”‹‰–Š‡”‡ ‘˜‡”›’‡”‹‘†ȋ•–—†›

(60)

(61)

(62) Ǧ

(63) ȌǤ–Š‘”‘—‰Š ‘™Ž‡†‰‡‘ˆ–Š‡•‡ƒ––‡”•‹•ƒ’”‡Ǧ”‡“—‹•‹–‡ˆ‘”†‡•‹‰‹‰ˆ‘ŽŽ‘™Ǧ—’’”‘‰”ƒ• –ƒ‹Ž‘”‡†–‘‹†‹˜‹†—ƒŽ•—”‰‹ ƒŽ’”‘ ‡†—”‡•Ǥ”‡˜‹‘—•‹˜‡•–‹‰ƒ–‹‘•Šƒ˜‡•Š‘™–Šƒ– •‘‡‘ˆ–Š‡‡›’‘‹–•ˆ‘”‰‘‘†”‡•—Ž–•ƒˆ–‡”ƒ”‡–Š‡‡˜ƒŽ—ƒ–‹‘ƒ†–”‡ƒ–‡–‘ˆ ’ƒ‹ǡƒ—•‡ƒƒ†˜‘‹–‹‰ǡ†‹œœ‹‡••ƒ†‘ˆ‘„‹Ž‹–›’”‘„Ž‡•ȋʹͲȌǤ ‡‘ˆ–Š‡ ŠƒŽŽ‡‰‡•‘ˆ–Š‡‡ƒ”Ž›”‡ ‘˜‡”›’Šƒ•‡‹•–‘™Šƒ–‡š–‡–ƒ—•‡ƒƒ†’ƒ‹ ‡†ƒ‰‡”–Š‡’‘••‹„‹Ž‹–›ˆ‘”–Š‡’ƒ–‹‡––‘”‡–—”Š‘‡Ǥ ”‘•–—†›

(64) ǡ‹–„‡ ƒ‡ Ž‡ƒ” –Šƒ–ƒŽƒ”‰‡—„‡”‘ˆ†‹ˆˆ‡”‡–ƒ’’”‘ƒ Š‡•–‘–Š‡•‡’”‘„Ž‡•ƒ”‡—•‡†ƒ–†‹ˆˆ‡”‡– Š‘•’‹–ƒŽ•Ǥ ”‡˜‹‘—••–—†‹‡•Šƒ˜‡•Š‘™–Šƒ–•‘‡”•Šƒ˜‡Ž‘™‡”‹ ‹†‡ ‡‘ˆ’‘•–‘’‡”ƒ–‹˜‡ ƒ—•‡ƒƒ†˜‘‹–‹‰–Šƒ‘Ǧ•‘‡”•ȋʹʹȌǤ

(65) –Šƒ•ǡŠ‘™‡˜‡”ǡ‘–„‡‡ Ž‡ƒ”™Š‡–Š‡” –Š‹•’Š‡‘‡‘‹•”‡Žƒ–‡†–‘–Š‡‹ ‘–‹‡ ‘–‡–‘ˆ ‹‰ƒ”‡––‡•‘‡ǡ‘”‹ˆ•‘‡ ‘–Š‡” ‘•–‹–—‡–‹•”‡•’‘•‹„Ž‡Ǥ•–—†›‘ˆ’‘•–‘’‡”ƒ–‹˜‡’ƒ‹ǡƒ†ƒƒŽ‰‡•‹  —•‡ƒ†–Š‡”‡Žƒ–‹‘–‘–Š‡•‡˜ƒ”‹ƒ„Ž‡•–‘–Š‡’”‡‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š’”‘ˆ‹Ž‡™ƒ• †‡•‹‰‡†ȋ•–—†›

(66)

(67) ȌǤ‹ ‡‹–‹•’‘••‹„Ž‡–Šƒ––Š‡‡š–‡–‘ˆƒ—•‡ƒƒ†’ƒ‹ƒ•™‡ŽŽƒ• ‘–Š‡”’‘•–‘’‡”ƒ–‹˜‡’”‘„Ž‡•‹‰Š–„‡‹ˆŽ—‡ ‡†„›–Š‡’”‡‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š’”‘ˆ‹Ž‡ǡ ™‡ƒƒŽ›•‡†–Š‡‹’ƒ –‘ˆ’”‡‘’‡”ƒ–‹˜‡’ƒ‹ǡƒƒŽ‰‡•‹ ƒ†‹ ‘–‹‡—•‡‘–Š‡‡ƒ”Ž› ”‡ ‘˜‡”›’Šƒ•‡Ǥ Š‡“—‡•–‹‘Šƒ•„‡‡”ƒ‹•‡†™Š‡–Š‡”‘’‹‘‹†Ǧ„ƒ•‡†’‘•–‘’‡”ƒ–‹˜‡’ƒ‹ ‘–”‘Ž‹• ‡ ‡••ƒ”›ƒˆ–‡”‘”‹ˆ•ƒ–‹•ˆƒ –‘”›’ƒ‹ ‘–”‘Žƒ›„‡ƒ Š‹‡˜‡†‹•‡Ž‡ –‡† ƒ•‡• ™‹–ŠƒƒŽ‰‡•‹ •‘ˆ‘–Š‡”‹†•ȋʹ͵ǦʹͶȌǤ

(68) ‘”†‡”–‘‹˜‡•–‹‰ƒ–‡–Š‹•ǡ™‡ƒƒŽ›•‡†’ƒ‹ ‘–”‘Žƒˆ–‡”ŠƒŽŽ—š˜ƒŽ‰—••—”‰‡”›Ǥ‡ ‘’ƒ”‡†–™‘†‹ˆˆ‡”‡–’ƒ‹”‡‰‹‡•Ǣ‡‹–Š‡” –”ƒƒ†‘Ž‘”‡–‘”‹ ‘š‹„ǡ‡˜ƒŽ—ƒ–‹‰‡ˆˆ‹ ƒ ›ƒ†’ƒ–‹‡–•ƒ–‹•ˆƒ –‹‘‹–Š‡‡ƒ”Ž› ’‘•–‘’‡”ƒ–‹˜‡’‡”‹‘†ǤŠ‡’ƒ–‹‡–•™‡”‡ˆ‘ŽŽ‘™‡†—’–‘ͳ͸™‡‡•ƒˆ–‡”•—”‰‡”›ƒ† ‘—– ‘‡™ƒ•ƒ••‡••‡†„‘–Š„›–Š‡’ƒ–‹‡–ƒ†„›–Š‡’Š›•‹ ‹ƒȋ•–—†›ȌǤ ͳʹ .

(69) . ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴. Aims. AIMS  Thegeneralaim: ToinvestigateroutinesofDS,painandrecoveryinDSpatientsandtoimprove knowledgeofthepostoperativecoursefordifferenttypicalDSprocedures  StudyI: ‘‰ƒ‹‹•‹‰Š–‹–‘”‘—–‹‡•ƒ†–‘‡š’Ž‘”‡–Š‡’”‡•‡–˜‘Ž—‡‘ˆ‹™‡†‡  StudyII: ‘‡˜ƒŽ—ƒ–‡–Š‡‡ƒ”Ž›”‡ ‘˜‡”›’Šƒ•‡ȋˆ‹”•–™‡‡Ȍƒˆ–‡”ƒ†–‘•–—†›–Š‡‹’ƒ –‘ˆ –‘„ƒ ‘—•‡‘’‘•–‘’‡”ƒ–‹˜‡’ƒ‹ǡƒ—•‡ƒƒ†˜‘‹–‹‰  StudyIII: ‘‹˜‡•–‹‰ƒ–‡’ƒ–‹‡–•ǯ•‡ŽˆǦƒ••‡••‡†”‡ ‘˜‡”›ǡˆ‘ —•‹‰‘†‡˜‡Ž‘’‡–ƒ† ”‡•–‘”ƒ–‹‘‘ˆŠ‡ƒŽ–Š”‡Žƒ–‡†“—ƒŽ‹–›‘ˆŽ‹ˆ‡†—”‹‰–Š‡ˆ‹”•–͵Ͳ†ƒ›•ƒˆ–‡”  StudyIV: ‘‡š’Ž‘”‡Ž‘‰‹–—†‹ƒŽ Šƒ‰‡•‹•‡ŽˆǦƒ••‡••‡†Š‡ƒŽ–Š’”‘ˆ‹Ž‡”‡Žƒ–‡†“—ƒŽ‹–›‘ˆŽ‹ˆ‡ †—”‹‰͸‘–Š•ƒˆ–‡”ǡ‹ Ž—†‹‰†‡• ”‹’–‹‘‘ˆ–Š‡‘”ƒŽ ‘—”•‡‘ˆ”‡•‘Ž—–‹‘‘ˆ ’”‡Ǧƒ†’‘•–Ǧ‘’‡”ƒ–‹˜‡•›’–‘•  StudyV: ‘•–—†›–Š‡‡ˆˆ‹ ƒ ›‘ˆƒ•–”— –—”‡†’ƒ‹ƒƒ‰‡‡–’”‘‰”ƒƒ†–‘ ‘’ƒ”‡ǡ‹ƒ ’”‘•’‡ –‹˜‡”ƒ†‘‹œ‡††‘—„Ž‡Ǧ„Ž‹††‡•‹‰ǡ–Š‡‡ˆˆ‡ –‘ˆ–™‘†‹ˆˆ‡”‡–’ƒ‹ ‡†‹ ƒ–‹‘•ǡ ‘š‹„•˜••Ž‘™”‡Ž‡ƒ•‡–”ƒƒ†‘Žƒ†–‘•–—†›”‡ ‘˜‡”›‹Ǧͷ†ƒˆ–‡”. . ͳ͵.

(70) DaySurgery____________________________________________________________________________________. MATERIALANDMETHODS ‡‡“—‡•–‹‘ƒ‹”‡•‹ƒ’’‡†‹š. StudyI:

(71) ʹͲͲ͸ǡƒ‡š–‡•‹˜‡“—‡•–‹‘ƒ‹”‡™ƒ••—’’Ž‹‡†–‘ͻʹ™‡†‹•Šƒƒ‡•–Š‡•‹‘Ž‘‰› †‡’ƒ”–‡–•ǡ™Š‘™‡”‡ƒ•‡†–‘ƒ•™‡”͵Ͳ“—‡•–‹‘•”‡‰ƒ”†‹‰ Ž‹‹ ƒŽ’”ƒ –‹ ‡ƒ† ”‘—–‹‡•ˆ‘”†—”‹‰ʹͲͲͷȋ–Š‡“—‡•–‹‘ƒ‹”‡‹•‘–•—’’Ž‹‡†‹–Š‡ƒ’’‡†‹š†—‡–‘ ‹–•‡š–‡–ȌǤŠ‹•“—‡•–‹‘ƒ‹”‡ ‘–ƒ‹‡†“—‡•–‹‘•ƒ„‘—–‘”‰ƒ‹•ƒ–‹‘ǡ—„‡”ƒ† –›’‡‘ˆ’”‘ ‡†—”‡•ǡ‡˜ƒŽ—ƒ–‹‘ǡ”‹•Ǧ•–”ƒ–‹ˆ‹ ƒ–‹‘ǡ’”‡Ǧ‡†‹ ƒ–‹‘ǡ’‘•–‘’‡”ƒ–‹˜‡ ”‘—–‹‡•ˆ‘”’ƒ‹ƒ†–”‡ƒ–‡–•ǡ†‹• Šƒ”‰‡ǡ‹ˆ‘”ƒ–‹‘ǡ‡• ‘”–ǡˆ‘ŽŽ‘™Ǧ—’ǡ ”‡ƒ†‹••‹‘ǡ‡™’”‘ ‡†—”‡•ƒ†ƒ„‘—–’”‡Ǧ†‡ˆ‹‡†’”‘ ‡†—”‡•‹ˆ•— Š™‡”‡ ’‡”ˆ‘”‡†ƒ•†ƒ› ƒ•‡•—”‰‡”›Ǥ ȋŠ‡“—‡•–‹‘ƒ‹”‡ƒŽ•‘‹ Ž—†‡†“—‡•–‹‘• ‘ ‡”‹‰͵–›’‹ ƒŽ’ƒ‡†‹ƒ–”‹  ’”‘ ‡†—”‡•ƒ†͵–›’‹ ƒŽƒ†—Ž–’”‘ ‡†—”‡•ǤŠ‡•‡”‡•—Ž–•ƒ”‡’”‡•‡–‡†‹ʹ •‡’ƒ”ƒ–‡ƒ”–‹ Ž‡•‘–‹ Ž—†‡†‹–Š‹•–Š‡•‹•ȌǤ. StudyIIͲIV: ƒ–ƒˆ‘”–Š‡•‡’”‘•’‡ –‹˜‡—Ž–‹Ǧ ‡–”‡“—‡•–‹‘ƒ‹”‡ˆ‘ŽŽ‘™Ǧ—’•–—†‹‡•™‡”‡ ‘ŽŽ‡ –‡†ˆ”‘ƒ—–—ʹͲͲ͸—–‹Ž•’”‹‰ʹͲͲͺǤŠ‡•–—†‹‡•‹˜‘Ž˜‡†͵†‹ˆˆ‡”‡– ‡–”‡•ǣ”˜‹ƒŠ‘•’‹–ƒŽˆ‘”‹‰—‹ƒŽŠ‡”‹ƒ”‡’ƒ‹”ȋ

(72) ȌǡƒŠŽ‰”‡•ƒ‹˜‡”•‹–› ‘•’‹–ƒŽȀڎ†ƒŽˆ‘”ƒ”–Š”‘• ‘’›’”‘ ‡†—”‡•ȋȌƒ† ƒŽÚ’‹‰‘•‡–‹ —”‰‡”› ‡–”‡ˆ‘” ‘•‡–‹ „”‡ƒ•–•—”‰‡”›ȋȌǤ ˆ–‡”‰‹˜‹‰ƒ†•‹‰‹‰ƒ‹ˆ‘”‡† ‘•‡–ˆ‘”ǡ–Š‡‹ Ž—†‡†’ƒ–‹‡–•™‡”‡ ”‡“—‹”‡†–‘ƒ•™‡”ƒ’”‡‘’‡”ƒ–‹˜‡“—‡•–‹‘ƒ‹”‡ȋƒ’’‡†‹šͳȌǤ

(73) –Š‡ǡ•’‡ ‹ƒŽŽ› †‡•‹‰ƒ–‡†—”•‡•”‡‰‹•–‡”‡†’ƒ‹ǡƒ—•‡ƒǡ‡†‹ ƒ–‹‘•ƒ†•‹†‡‡ˆˆ‡ –•Ǥ–†‹• Šƒ”‰‡ –Š‡’ƒ–‹‡–•”‡ ‡‹˜‡†“—‡•–‹‘ƒ‹”‡•–‘ˆ‹ŽŽ‹ƒ–Š‘‡ǡ–Š‡ˆ‹”•–†ƒ›ƒˆ–‡”•—”‰‡”›ƒ† ƒˆ–‡”ͳ™‡‡ȋƒ’’‡†‹šʹȌǤ—‡•–‹‘ƒ‹”‡•ƒ–’”‡†‡–‡”‹‡†‘ ƒ•‹‘•Ǣƒˆ–‡”ʹ™‡‡•ǡ Ͷ™‡‡•ǡ͵‘–Š•ƒ†͸‘–Š•ȋƒ’’‡†‹š͵Ȍǡ™‡”‡•‡––‘–Š‡’ƒ–‹‡–•–‘‰‡–Š‡” ™‹–Š’”‡Ǧ’”‡’ƒ”‡†‡˜‡Ž‘’‡•–‘„‡”‡–—”‡†„›ƒ‹Žȋ–ƒ„Ž‡ͳȌǤ ™‘”‡‹†‡”–‡Ž‡’Š‘‡ ƒŽŽ•‘”ƒ‹Ž•™‡”‡•‡–‹ ƒ•‡‘ˆ‘”‡’Ž›ǤŠ‡–Š‡ ’ƒ–‹‡–•™‡”‡ˆ—ŽŽ›”‡ ‘˜‡”‡†ǡ–Š‡‡†Ǧ’‘‹–™ƒ•”‡ƒ Š‡†ƒ†‘‘”‡“—‡•–‹‘ƒ‹”‡• ™‡”‡•‡–ǤŽŽ“—‡•–‹‘•Šƒ†–Š‡•–”— –—”‡†ƒŽ–‡”ƒ–‹˜‡•Dz›‡•dzƒ†Dz‘dzǡ–‘‰‡–Š‡”™‹–Š ƒ’‘••‹„‹Ž‹–›–‘Ž‡ƒ˜‡ ‘‡–•Ǥ. ͳͶ .

(74) . . MaterialandMethods. Table 1: Time points for patient assessed questionnaires in studies II-IV. Time:. PreRecovery Day 1 operative room. 1 week. 2 weeks. 4 weeks. 3 months. 6 months. Study no: 3 4 5  Š‡ƒŒ‘”ƒƒ‡•–Š‡–‹ ‡–Š‘†™ƒ•‰‡‡”ƒŽƒƒ‡•–Š‡•‹ƒ™‹–ŠŽƒ”›‰‡ƒŽƒ•Ǥƒ‹ ™ƒ•–”‡ƒ–‡†—•‹‰–Š‡—Ž–‹‘†ƒŽƒ’’”‘ƒ ŠǢ’”‡‘’‡”ƒ–‹˜‡’ƒ”ƒ ‡–ƒ‘Ž–‘ƒŽŽ’ƒ–‹‡–•ǡ 

(75) –‘•‘‡ǡ•–‡”‘‹†•’‡”Ǧ‘”’‘•–Ǧ‘’‡”ƒ–‹˜‡Ž›‘Ž›‹ˆƒ—•‡ƒǡƒ†Ž‘ ƒŽƒƒ‡•–Š‡•‹ƒ ƒ––Š‡•—”‰‹ ƒŽ•‹–‡Ǥ‘•–Ǧ‘’‡”ƒ–‹˜‡ƒƒŽ‰‡•‹ •™‡”‡‰‹˜‡ƒ•‹–”ƒ˜‡‘—•‘’‹‘‹†‹ˆ ‡‡†‡†ƒ–ǡ’ƒ”ƒ ‡–ƒ‘Žƒ†ƒ™‡ƒ‘’‹‘‹†‹ˆ‡‡†‡†ƒ–Š‘‡–‘‰‡–Š‡”™‹–Šƒ 

(76) Ǥ. StudyV: ƒ–‹‡–•• Š‡†—Ž‡†ˆ‘”ŠƒŽŽ—š˜ƒŽ‰—••—”‰‡”›™‡”‡”ƒ†‘‹•‡†–‘ʹ†‹ˆˆ‡”‡–‘”ƒŽ ƒƒŽ‰‡•‹ –”‡ƒ–‡–‰”‘—’•„›ƒ ‘’—–‡”’”‘ ‡†—”‡ǤŠ‡ˆ‹”•–‰”‘—’™ƒ• ’‘•–‘’‡”ƒ–‹˜‡Ž›–”‡ƒ–‡†™‹–Š‡–‘”‹ ‘š‹„ͳʹͲ‰šͳˆ‘”Ͷ†ƒ›•ƒ†–Š‡ͻͲ‰šͳˆ‘” ͵†ƒ›•ǤŠ‡•‡ ‘†‰”‘—’”‡ ‡‹˜‡†•—•–ƒ‹‡†”‡Ž‡ƒ•‡–”ƒƒ†‘ŽͳͲͲ‰šʹˆ‘”͹†ƒ›•Ǥ Š‘•’‹–ƒŽ’Šƒ”ƒ ‹•–’”‡’ƒ”‡†–Š‡•–—†›‡†‹ ƒ–‹‘‹‹†‡–‹ ƒŽǦƒ’’‡ƒ”‹‰ ƒ’•—Ž‡•Ǥ Š‡ˆ‹”•–‰”‘—’”‡ ‡‹˜‡†’Žƒ ‡„‘ƒ––Š‡ƒˆ–‡”‘‘†‘•ƒ‰‡–‘„Ž‹†–Š‡ ‘–‡––‘ ’ƒ–‹‡–ƒ†•–ƒˆˆǤŽŽ’ƒ–‹‡–•™‡”‡’”‘˜‹†‡†’ƒ”ƒ ‡–ƒ‘Žƒ•ˆ‹”•–Ž‹‡”‡• —‡ ‡†‹ ƒ–‹‘ǡƒ†‘”ƒŽ‘š› ‘†‘‡ͷ‰‹ƒ‡• ƒŽƒ–‹‰ƒ‡”ƒ••‡ ‘†Ž‹‡”‡• —‡ǡ‹ˆ ‡‡†‡†Ǥ Š‡•ƒ‡’‡”‹‘’‡”ƒ–‹˜‡’”‘–‘ ‘Ž™ƒ•—•‡†ˆ‘”ƒŽŽ’ƒ–‹‡–•Ǥˆ–‡”ͺ‰‘ˆ „‡–ƒ‡–Šƒ•‘‡‹˜ǡ‰‡‡”ƒŽƒƒ‡•–Š‡•‹ƒ™‹–ŠƒŽˆ‡–ƒ‹Žǡ’”‘’‘ˆ‘Žƒ†•‡˜‘ˆŽ—”ƒ‡™ƒ• —•‡†Ǥ Š‡’ƒ–‹‡–•ˆ‹ŽŽ‡†‹ƒ†ƒ‹Ž›†‹ƒ”›–Š‡͹ˆ‹”•–†ƒ›•ƒˆ–‡”•—”‰‡”›ǤŠ‡›ƒ•™‡”‡† “—‡•–‹‘•ȋƒ’’‡†‹šͶȌƒ„‘—–™‘”•–’ƒ‹ƒ†’ƒ‹”‡Ž‹‡ˆ—•‹‰ƒǦ• ƒŽ‡ǡ •ƒ–‹•ˆƒ –‹‘ƒ†‡š’‡”‹‡ ‡‘ˆ•‹†‡‡ˆˆ‡ –•ǤŠ‡’ƒ–‹‡–•™‡”‡ƒŽ•‘”‡“—‹”‡†–‘ƒ•™‡” ƒǦͷ†“—‡•–‹‘ƒ‹”‡ƒ†ƒ“—ƒŽ‹–›‘ˆŽ‹ˆ‡• ƒŽ‡ȋͲǦͳͲͲȌ’”‡‘’‡”ƒ–‹˜‡Ž›ƒ†ƒ– ͳ͸™‡‡•Ǥ ˆ–‡”ͳʹǦͳ͸†ƒ›•ǡƒŽŽ’ƒ–‹‡–•™‡”‡•‡‡„›ƒ”‡•‡ƒ” Š—”•‡–‘”‡‘˜‡•–‹– Š‡•ƒ†–‘ ‡˜ƒŽ—ƒ–‡™‘—†Š‡ƒŽ‹‰Ǥˆ–‡”ͳʹ™‡‡•ǡƒǦ• ƒ™ƒ•’‡”ˆ‘”‡†–‘†‹ƒ‰‘•‡•‹‰• ‘ˆ‹’ƒ‹”‡†„‘‡Š‡ƒŽ‹‰Ǥ–ͳ͸™‡‡•ƒˆ–‡”•—”‰‡”›ǡƒ’Š›•‹ ‹ƒƒ••‡••‡†Š‡ƒŽ‹‰ƒ† ˆ— –‹‘ƒŽ‹–›–‘‰‡–Š‡”™‹–Š–Š‡’ƒ–‹‡–‹ƒ••‘ ‹ƒ–‹‘™‹–ŠƒǦͷ†“—‡•–‹‘ƒ‹”‡ ƒ••‡••‡–Ǥ . ͳͷ.

(77) DaySurgery____________________________________________________________________________________.  Questionnaires,EQͲ5dand8Ͳitemhealthprofile: —”‘—ƒŽ‹–›ͷ†‹‡•‹‘•ȋͷ†Ȍ‹•ƒ•–ƒ†ƒ”†‹œ‡†‹•–”—‡–ˆ‘”‡ƒ•—”‡‡–‘ˆ Š‡ƒŽ–Š•–ƒ–—•ƒ†‘—– ‘‡ȋʹͷȌǤ

(78) –‹•ˆ”‡“—‡–Ž›—•‡†‹ Ž‹‹ ƒŽ“—‡•–‹‘ƒ‹”‡• „‡ ƒ—•‡‹–‹•‡ƒ•›–‘—•‡ƒ•ƒ•‡ŽˆǦ”‡’‘”–‹•–”—‡–ǤŠ‹•†‡• ”‹’–‹˜‡•›•–‡‘ˆŠ‡ƒŽ–ŠǦ ”‡Žƒ–‡†“—ƒŽ‹–›‘ˆŽ‹ˆ‡•–ƒ–—•ǡ ‘•‹•–•‘ˆ–Š‡ˆ‹˜‡†‹‡•‹‘•Ǣ’ƒ‹Ȁ†‹• ‘ˆ‘”–ǡ ‘„‹Ž‹–›ǡ•‡ŽˆǦ ƒ”‡ǡ—•—ƒŽƒ –‹˜‹–‹‡•ƒ†‘‘†Ȁ†‡’”‡••‹‘ǤŠ‡”‡•’‘•‡•Šƒ˜‡͵ Ž‡˜‡Ž•Ǣ‘’”‘„Ž‡ǡ•‘‡’”‘„Ž‡•ǡ‡š–”‡‡’”‘„Ž‡•Ǥ

(79) •–—†›

(80)

(81) Ǧ

(82) ǡ™‡—•‡†ƒ“—‡•–‹‘ƒ‹”‡„ƒ•‡†‘–Š‡•‡„ƒ•‹ ͷǦͷ††‘ƒ‹•„—– ‹ Ž—†‡†ƒŽ•‘“—‡•–‹‘•ƒ„‘—–•Ž‡‡’ǡ‹’ƒ‹”‡†•‡š—ƒŽƒ –‹˜‹–›ƒ†‡‡†ˆ‘”ƒƒŽ‰‡•‹ •Ǥ Š‡”‡™‡”‡–™‘ƒŽ–‡”ƒ–‹˜‡•ǡ‘Ž››‡•ƒ†‘ȋƒ’’‡†‹šͳǡ͵ȌǤ

(83) •–—†›ǡ–Š‡‘”ƒŽǦͷ†“—‡•–‹‘ƒ‹”‡™‹–Šͷ†‹‡•‹‘•ƒ†‹ƒ††‹–‹‘–Š‡ ‘• ƒŽ‡ǡ™ƒ•—•‡†ȋ‡Ǥ‰Ǥ–Š‡ˆ‹”•–‘”‹‰ƒˆ–‡”‘’‡”ƒ–‹‘ǡƒ’’‡†‹šͶȌǤ. Statistics: ŽŽƒƒŽ›•‡•™‡”‡’‡”ˆ‘”‡†—•‹‰–Š‡–ƒ–‹•–‹ ƒŽƒ ƒ‰‡ˆ‘”–Š‡‘ ‹ƒŽ ‹‡ ‡• ȋȌ˜‡”•‹‘ͳͷǤͲǤ ‘–‹—‘—•†ƒ–ƒ™ƒ•ƒƒŽ›•‡†„›–Ǧ–‡•–•ˆ‘”–™‘Ǧ‰”‘—’ ‘’ƒ”‹•‘•ƒ†„› ˆ‘”—Ž–‹’Ž‡‰”‘—’ ‘’ƒ”‹•‘•ǡ™Š‡ƒ‘”ƒŽ†‹•–”‹„—–‹‘‘ˆ†ƒ–ƒ ‘—Ž†”‡ƒ•‘ƒ„Ž› „‡ƒ••—‡†Ǥ

(84)  ƒ•‡•™Š‡”‡–Š‹•ƒ••—’–‹‘™ƒ•‘– ‘•‹†‡”‡†˜ƒŽ‹†ǡƒ ‹• Š‡”•–‡•– ™ƒ•—•‡†ǤŠ‡ƒ••Ǧ•‹‰‹ˆ‹ ƒ ‡’”‘„Ž‡™ƒ•ƒ††”‡••‡†„›—•‹‰‘ˆ‡””‘‹ ‘””‡ –‹‘•‘ˆ•‹‰‹ˆ‹ ƒ ‡Ž‡˜‡Ž•™Š‡”‡ƒ’’”‘’”‹ƒ–‡Ǥ ƒ–‡‰‘”‹ ƒŽ†ƒ–ƒ™‡”‡ ‘’ƒ”‡†—•‹‰Š‹Ǧ•“—ƒ”‡–‡•–•ˆ‘”‹†‡’‡†‡–‰”‘—’•ƒ†  ‡ƒ”•–‡•–ˆ‘”†‡’‡†‡–ȋ”‡’‡ƒ–‡†‡ƒ•—”‡•Ȍ†ƒ–ƒǤ ‘‰‹•–‹ ”‡‰”‡••‹‘™ƒ•—•‡†‹•–—†›

(85)

(86) ǡˆ‘”‡˜ƒŽ—ƒ–‹‘‘ˆ†‹ˆˆ‡”‡ ‡•‘˜‡”–‹‡ „‡–™‡‡–Š‡‰‡†‡”•Ǥ ‘–‹—‘—•†ƒ–ƒ‹•’”‡•‡–‡†ƒ•‡ƒ•ƒ†•–ƒ†ƒ”††‡˜‹ƒ–‹‘•ǡ ƒ–‡‰‘”‹ ƒŽ†ƒ–ƒƒ• ˆ”‡“—‡ ‹‡•Ǥ ‘”ƒŽŽ•–ƒ–‹•–‹ ƒŽƒƒŽ›•‡•ǡƒ•‹‰‹ˆ‹ ƒ ‡Ž‡˜‡Ž‘ˆ’δͲǤͲͷ™ƒ•—•‡†Ǥ. ͳ͸ .

(87) . . StudySubjects. STUDYSUBJECTS StudyI: Š‡ˆ‘ŽŽ‘™‹‰ͻʹŠ‘•’‹–ƒŽ•™‡”‡ƒ•‡†  Ž‹‰•¤• ƒ†•”‘ƒ. ††‡˜ƒŽŽƒ. ”˜‹ƒ. ‹†Ú’‹‰. ‡¤Ȃ͵—‹–•. ‘”¤•. ‹†‡•„‡”‰. ’’•ƒŽƒȂ͵—‹–•. ¡ ‡ˆ‘”•. ‹Ú’‹‰. ƒ”„‡”‰. •ŒÚ. Œ—‰„›. ‹•„›. Ú’‹‰. —Ž‡¤. ¡”ƒ‘. •‹Ž•–—ƒ. —†. ¡•–‡”˜‹. ƒŽ‡„‡”‰. › •‡Ž‡. ¡•–‡”¤•. ƒŽÚ’‹‰. ƒŽÚ. ¡šŒÚ. ƒŽ—. ‘”ƒ. •–ƒ†. ‹•’¤‰. ƒ ƒ. "‰‡ŽŠ‘Ž. ¡ŽŽ‹˜ƒ”‡. ‘””–¡ŽŒ‡. Y”‡„”‘ǦͶ—‹–•. ږ‡„‘”‰Ǧ͸—‹–•. ›Ú’‹‰. Y”•ÚŽ†•˜‹. ƒŽ•–ƒ†. •ƒ”•Šƒ. Y•–‡”•—†. ‡Ž•‹‰„‘”‰. ‹–‡¤. —†‹•˜ƒŽŽ. ƒ†˜‹‡. ¡••Ž‡Š‘Ž. ‡ŽŽ‡ˆ–‡¤. ڐÚ’‹‰. ‡‡. ƒŽ‹š. Ú˜†‡. ƒŽƒ”. ‘ŽŽ‡ˆ–‡¤. ƒ”Ž•Šƒ. –‘ Š‘ŽȂͳͳ—‹–•. ƒ”Ž•‘‰ƒ. –”ڏ•–ƒ†. ƒ”Ž•”‘ƒ. —†•˜ƒŽŽ. ƒ”Ž•–ƒ†. چ‡”–¡ŽŒ‡. ƒ–”‹‡Š‘Ž. ‘”•„›. ”‹•–‹ƒ•–ƒ†. ”‡ŽŽ‡„‘”‰. —‰•„ƒ ƒ. ”‘ŽŽŠ¡––ƒ. —‰¡Ž˜. ¡„›. . ͳ͹.

(88) DaySurgery____________________________________________________________________________________. StudiesIIͲIV Table2a:ThestudysubjectsinstudyII,IIIandIV:. Number allocated Number included Age (mean years) Smokers and/or snuffers Gender M/F % Hospital ASA 1 ASA 2 ASA 3 ASA 4 ASA miss. IHR 120. AS 132. CBA 138. Total 390. 107 63. 122 42. 126 27. 355 41. 29. 42. 41. 112. 82/18 Arvika 58 42 5 2. 52/48 Mölndal 91 21 4 6 -. 0/100 Falköping 114 4 8. 43/57 263 67 9 6 10. StudyV Table2b:ThestudysubjectsinstudyV. Number asked Number included Age (mean years) Smokers Gender M/F % ASA 1 ASA 2. ͳͺ . Etoricoxib 50 49 47r11 7 0/100 41 8. Tramadol 50 49 51r10 7 0/100 40 9. Total 100 98 49 14 0/100 81 17.

(89) . ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴. Results. REVIEWofRESULTS StudyI ˆ–Š‡ͻʹ™‡†‹•ŠŠ‘•’‹–ƒŽ•ǡͺͳƒ•™‡”‡†”‡•—Ž–‹‰‹ƒ”‡•’‘•‡”ƒ–‡‘ˆͺͺΨǤ™‘‘ˆ –Š‡Š‘•’‹–ƒŽ•™‡”‡‘Ž›ˆ‘” Š‹Ž†”‡ǤŠ‡ͳͳ‘Ǧ”‡•’‘†‡”•™‡”‡‡˜‡Ž›†‹•–”‹„—–‡† ƒ ”‘••™‡†‡ƒ†‘ˆ†‹ˆˆ‡”‡–•‹œ‡•Ǥ

(90) ʹͲͲͷ‘”‡–ŠƒͷͲΨ‘ˆƒŽŽ™‡†‹•Š•—”‰‹ ƒŽ ’”‘ ‡†—”‡•™‡”‡’‡”ˆ‘”‡†ƒ•Ǥ‘ƒ„•‘Ž—–‡—’’‡”Ž‹‹–‘ˆ™‡‹‰Š–‘”ƒ‰‡™ƒ• ˆ‘—†Ǣ͵ʹΨ‘ˆ–Š‡—‹–•”‡’‘”–‡†ƒ—’’‡”Ž‹‹–ˆ‘”

(91) ƒ–͵ͷǡͳʹΨ‘ˆ–Š‡—‹–•—•‡† ƒ—’’‡”Ž‹‹–‘ˆ͹ͷ›‡ƒ”•‹ˆ‰‡‡”ƒŽƒƒ‡•–Š‡•‹ƒ™ƒ• ‘•‹†‡”‡†‡ ‡••ƒ”›Ǥ ”‘—–‹‡•‹™‡†‡™‡”‡ˆ‘—†–‘„‡ƒŽ‘•–•‹‹Žƒ”„‡–™‡‡ ‡–”‡•ƒ†™‹–Šƒ Š‹‰Š†‡‰”‡‡‘ˆ•–ƒ†ƒ”†‹•ƒ–‹‘Ǥ‡ƒŽ•‘ˆ‘—†–Š‡”‘—–‹‡••‹‹Žƒ”–‘ ‘‘ ‹–‡”ƒ–‹‘ƒŽ’”ƒ –‹ ‡Ǥ

(92) ˆ‹‰—”‡ͳǡ”‘—–‹‡•—•‡†„›†‹ˆˆ‡”‡–—‹–•ƒ”‡•Š‘™‹ ’‡” ‡–‘ˆƒŽŽ”‡•’‘†‹‰—‹–•Ǥ Figure1: ”‡“—‡ ‹‡•‘ˆ’‡”ˆ‘”‡†”‘—–‹‡•ƒ–ƒŽŽ™‡†‹•Š†ƒ›•—”‰‡”›—‹–•ǡΨ 0. 10. 20. 30. 40. 50. 60. 70. 80. 90. 100. Preoperativeassessment Healthquestionnaire RiskstratificationforPONV Oralpremedication Premedicationwithanxiolytics Analgesiastartingpreoperatively Multimodalpaintreatmentregime Standardizeddischargecriteria Escortondischarge Reporttoprimaryhealthcare Writteninformationaboutsurgery Informationaboutpaintreatment TelephoneͲnumberforinformation. ŽŽŠ‘•’‹–ƒŽ•”‡’‘”–‡†’ƒ‹–‘„‡–Š‡ƒ‹’”‘„Ž‡ƒˆ–‡”Ǥ‘•–—‹–••–ƒ”–‡†’ƒ‹ –”‡ƒ–‡–ƒŽ”‡ƒ†›™‹–Š’”‡‡†‹ ƒ–‹‘Ǥƒ”ƒ ‡–ƒ‘Ž™ƒ•—•‡†„›ͻͷΨǡ

(93) „›͹͵Ψ ƒ† ‘š‹„•‘Ž›„›ƒˆ‡™—‹–•Ǥ–ƒ‡ƒ• ‘”‡‘ˆε͵Ǥ͸ǡ”‡• —‡‡†‹ ‹‡™ƒ• ‰‹˜‡ǡ’ƒ”‡–‡”ƒŽŽ›‡–‘„‡‹†‘‡™ƒ•–Š‡‘•– ‘‘ƒ††Ǧ‘ƒƒŽ‰‡•‹ —•‡†Ǥ• –ƒ‡ǦŠ‘‡‡†‹ ƒ–‹‘ǡ’ƒ”ƒ ‡–ƒ‘Ž™ƒ•—•—ƒŽŽ›•—’’Ž‹‡†ƒ•ƒ„ƒ•‡ǡ™‡ƒ‘’‹‘‹†• . ͳͻ.

(94) DaySurgery____________________________________________________________________________________. ™‡”‡’”‘˜‹†‡†ˆ‘”ͳǦ͵†ƒ›•‹ˆ‘†‡”ƒ–‡’ƒ‹™Š‹Ž‡‘š› ‘†‘‡™ƒ•’”‘˜‹†‡†ˆ‘” •‡˜‡”‡’ƒ‹„›ͶʹΨ‘ˆ—‹–•Ǥ. StudyIIͲIV

(95) –Š‡•‡•–—†‹‡•ǡ͵ͻͲ’ƒ–‹‡–•ƒ‰”‡‡†–‘’ƒ”–‹ ‹’ƒ–‡ǢͳʹͲ‹‰—‹ƒŽŠ‡”‹ƒ”‡’ƒ‹”•ȋ

(96) Ȍǡ ͳ͵ʹƒ”–Š”‘• ‘’‹ ’”‘ ‡†—”‡•ȋȌƒ†ͳ͵ͺ ‘•‡–‹ „”‡ƒ•–ƒ—‰‡–ƒ–‹‘•ȋȌ™ƒ• • ”‡‡‡†Ǥ ͵ͷ‘—–‘ˆ–Š‡•‡͵ͻͲ‡Ž‹‰‹„Ž‡’ƒ–‹‡–•™‡”‡‡š Ž—†‡††—‡–‘ǣ x x x x. ƒ‰—ƒ‰‡†‹ˆˆ‹ —Ž–‹‡• —”‰‡”›™ƒ• Šƒ‰‡†–‘ƒ‘”‡‡š–‡•‹˜‡’”‘ ‡†—”‡Ž‡ƒ†‹‰–‘‹ǦŠ‘•’‹–ƒŽ•–ƒ› ƒ–‹‡– Šƒ‰‡†–Š‡‹”‹†„‡ˆ‘”‡†‹• Šƒ”‰‡ƒ††‹†‘–™ƒ––‘’ƒ”–‹ ‹’ƒ–‡ ‹‰‡† ‘•‡–™ƒ•‹••‹‰. ƒ–‹‡–•ǯ’”‡‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š’”‘ˆ‹Ž‡ȋ–ƒ„Ž‡͵Ȍ™ƒ•—•‡†ƒ•„ƒ•‡Ž‹‡†ƒ–ƒˆ‘”–Š‡͵ †‹ˆˆ‡”‡–•—”‰‡”›‰”‘—’•Ǥ ‡ƒ†ƒ Š‡ǡ•‹ ǦŽ‹•–‡†‘”™ƒ‹–‹‰–‹‡™ƒ•‘–‹ Ž—†‡†‹ –Š‡”‡ ‘˜‡”›Š‡ƒŽ–Š’”‘ˆ‹Ž‡Ǥ Table3:”‡‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š’”‘ˆ‹Ž‡‹numbersƒ†%ȋˆ”‘ǦͷǦ“—‡•–‹‘•Ǣpain, mobility,depression,selfcare,usualactivitiesƒ†͸ƒ††‹–‹‘ƒŽ‹–‡•ȌǤ. 1. Pain trouble 2. Mobility problems 3. Depressed mood 4. Difficulties to manage self-care 5. Socially inactive outside home 6. Sleeping disturbance Headache 7. Disability to sex 8. Need of analgesics >3 times/week Sick-listed > 1week before surgery A waiting time > 3 month before surgery. ȗ’δͲǡͲͷ„‡–™‡‡‰”‘—’•Ǥ . ʹͲ . IHR. AS. CBA,. %. n=107 52 * 33 * 11 2 19 20 14 21 15 14 75. n=122 80 * 68 * 21 2 18 30 20 8 29 31 70. n=126 6 9 6 2 10 5 14 9 4 7 25. of all 40% 31% 11% 2% 13% 15% 15% 11% 14% 15% 48%.

(97) . ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴. Results. ƒ‹ƒ–™ƒ•”ƒ–‡†„›–Š‡˜‹•—ƒŽƒƒŽ‘‰—‡• ƒŽ‡ȋȌˆ‘”–Š‡͵‰”‘—’•ǡƒ–”‡•– ƒ†ƒ–ƒ„—Žƒ–‹‘ȋˆ‹‰—”‡ʹȌ•Š‘™‹‰–Šƒ–͵͸Ψ‘ˆ’ƒ–‹‡–•Šƒ†ƒ• ‘”‡†ε͵ƒ– ƒ„—Žƒ–‹‘ȋ–ƒ„Ž‡ͶȌǤ–”‡•––Š‡‡ƒ• ‘”‡™ƒ•ˆ‘”

(98) ͳǤ͹ǡˆ‘”ͳǤ͹ƒ†ˆ‘” ͵Ǥ͸Ǥ‘–Šƒ–†‹• Šƒ”‰‡ƒ†–Š‡ˆ‹”•–†ƒ›ǡ–Š‡‰”‘—’Šƒ†‘”‡’ƒ–‹‡–•‹’ƒ‹ ‘’ƒ”‡†–‘

(99) ƒ†‰”‘—’•Ǥ ”‡‘’‡”ƒ–‹˜‡‹ ‘–‹‡—•‡ƒ†ƒƒŽ‰‡•‹  ‘•—’–‹‘•†‹†‘– Šƒ‰‡–Š‡’ƒ‹ ˆ”‡“—‡ ›ƒ–ǡ™Š‹Ž‡’ƒ–‹‡–•™‹–Š’”‡‘’‡”ƒ–‹˜‡’ƒ‹™‡”‡•‹‰‹ˆ‹ ƒ–Ž› ƒ••‘ ‹ƒ–‡†™‹–Š‘”‡’ƒ‹ȋ–ƒ„Ž‡ͷ„ȌǤŠ‡‰”‘—’‘ˆ’ƒ–‹‡–•—•‹‰‹ ‘–‹‡Šƒ†ˆ‡™‡” ‹†‹˜‹†—ƒŽ•„‘–Šƒ–Š‘•’‹–ƒŽƒ†–Š‡ˆ‹”•–†ƒ›ƒ–Š‘‡ǡ”ƒ–‹‰’ƒ‹ǡŠ‘™‡˜‡”ǤŠ‡•‡ ˆ‹†‹‰•™‡”‡‘– ‘•‡“—‡–Ž›•‹‰‹ˆ‹ ƒ–Ǥ. Table 4: Patients in pain at different time points (%) from all included Time points PACU At discharge Day 1 1 week 2 weeks 4 weeks. IHR + AS + CBA n= 355 36 % VAS > 3 at ambulation 56 % 40 % 28 % 20 %. Nicotine-user. Non-nicotine-user. 27 % 49 %. 44 % 58 %. ‹ ‘–‹‡—•‡„›•‘‹‰ƒ†‘”•—ˆˆ‹‰™ƒ•ˆ‘—†–‘”‡†— ‡–Š‡’”‘„ƒ„‹Ž‹–›ˆ‘” ƒ—•‡ƒ‹„‘–Š‰‡†‡”•ƒ–”‡ ‘˜‡”›ǤŽ†‡”Ž›’ƒ–‹‡–•ƒ†‰‡†‡”‡Šƒ†–Š‡Ž‡ƒ•– ”‹•ˆ‘”ƒ—•‡ƒȋ–ƒ„Ž‡ͷ„ǡ͸ƒ†ˆ‹‰—”‡ʹƒ ”‡ƒ–‡†ˆ”‘ˆ‹‰—”‡•‹–ƒ„Ž‡͸ȌǤŠ‹•”‡•—Ž– ‹†‹ ƒ–‡•–Šƒ–‹ ‘–‹‡—•‡ ‘—Ž†„‡‹’‘”–ƒ–‹ˆ‘”ƒ–‹‘‹’”‡‘’‡”ƒ–‹˜‡”‹• ƒ••‡••‡–ǡƒ†ƒˆˆ‡ –’”‡‘’‡”ƒ–‹˜‡ƒ—•‡ƒ’”‘’Š›Žƒš‹•Ǥ. . ʹͳ.

(100) DaySurgery____________________________________________________________________________________.  Table6:‹•ˆ‘”ƒ—•‡ƒ‹–Š‡”‡ ‘˜‡”›”‘‘ȋȌ. ʹʹ .

(101) . ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴. Results. Figure2a:”‘„ƒ„‹Ž‹–›‘ˆƒ—•‡ƒƒ–”‡ ‘˜‡”›ˆ‘”‡Ȁ™‘‡ƒ†ƒ‰‡ȋ•’Ž‹‡ ˆ— –‹‘ǡŽ‘‰‹•–‹ ”‡‰”‡••‹‘Ȍ  . . ʹ͵.

(102) DaySurgery____________________________________________________________________________________. Š‡™‡ˆ‘ŽŽ‘™‡†–Š‡†‡˜‡Ž‘’‡–ƒ†”‡•–‹–—–‹‘‘ˆ•›’–‘•‹‘—”ͺǦ‹–‡Š‡ƒŽ–Š “—ƒŽ‹–›’ƒ”ƒ‡–‡”•ǡ™‡ˆ‘—†ǡ™Š‡ ‘•‹†‡”‹‰–Š‡™Š‘Ž‡‰”‘—’ǡ–Šƒ–‘•–‘ˆ–Š‡ ’ƒ–‹‡–•™‡”‡ƒŽ‘•–”‡•–‹–—–‡†ͳͶ†ƒ›•ƒˆ–‡”•—”‰‡”›ȋˆ‹‰—”‡͵ȌǤ Figure3:‡” ‡–’ƒ–‹‡–•”‡’‘”–‹‰‹’ƒ‹”‡–‹Š‡ƒŽ–Š”‡Žƒ–‡†“—ƒŽ‹–›‘ˆŽ‹ˆ‡ǡ ”‡Žƒ–‡†–‘–Š‡‹”•—”‰‹ ƒŽ’”‘ ‡†—”‡ǡ•’‡ ‹ˆ‹ ˆ‘”‡ƒ Š‹–‡ȋα͵ͷͷȌ. 60 50. pain mobility mood sel-care activity sleep sex analgesics. 40 30 20 10 0 preop. day 7. day 14.  ƒŽ›•‹‰‡˜‡”›‰”‘—’ˆ‘”–Š‡•ƒ‡‹–‡•ǡ™‡ˆ‘—†‹’”‘˜‡‡–• ‘’ƒ”‡†–‘–Š‡ ’”‡‘’‡”ƒ–‹˜‡’”‘ˆ‹Ž‡ˆ‘”–Š‡

(103) ‰”‘—’ǡ„‘–Š‹’”‘˜‡‡–•ƒ†™‘”•‡‹‰ˆ‘”–Š‡ ‰”‘—’ƒ†‘•–™‘”•‡‹‰ˆ‘”–Š‡‰”‘—’†—”‹‰–Š‡ˆ‹”•–ʹ’‘•–‘’‡”ƒ–‹˜‡™‡‡• ȋ–ƒ„Ž‡͹ȌǤ. ʹͶ .

(104) . ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴. Results. Table7:Šƒ‰‡•ƒ†’”‘’‘”–‹‘‘ˆ’ƒ–‹‡–•‹‡ƒ Š‰”‘—’•–—†‹‡†ǡ‹–Š‡ͺǦ‹–‡ Š‡ƒŽ–Š’”‘ˆ‹Ž‡“—‡•–‹‘•ƒ–ʹ™‡‡•ƒ• ‘’ƒ”‡†–‘„ƒ•‡Ž‹‡ȋ’”‡‘’‡”ƒ–‹˜‡Ž›ȌǤŽŽ ˆ‹‰—”‡•‹Ψ IHR 1.Pain 2.Mobility 3.Mood 4.Self-care 5.Activity 6.Sleep 7.Sex 8.Need for analgesics . AS. 49-30 Im * 29-21 Im 10-2 Im 2-0 Im 18-5 Im 19-2 Im 20-14 Im. 66-45 Im ** 56-64 W ** 17-10 Im 2-18 W 15-14 Im 25-17 Im 7-20 W. 5-42 W*** 6-37 W*** 5-6 W 2-8 W 8-4 Im 4-19 W 7-11 W. Entire cohort 40-39 Im 31-41 W 11-6 Im 2-9 W 13-8 Im 15-13 Im 11-15 W. 14-9 Im. 24-28 W. 3-32 W. 14-23 W. ͺ ‹’”‘˜‡† Ͷ‹’”ȀͶ™‘”•. CBA. ͳ‹’”Ȁ͹™‘”•. Ͷ‹’”ȀͶ™‘”•. Im’”‘˜‡† W‘”•‡‹‰ ȗ’δͲǡͲͷǡȗȗ’δͲǡͲͲͳǡȗȗȗ’δͲǡͲͲͲͳ ƒ‹™ƒ•–Š‡ƒ‹†‹•ƒ„‹Ž‹–›ˆ‘”ƒŽŽ’ƒ–‹‡–•†—”‹‰–Š‡™Š‘Ž‡ˆ‘ŽŽ‘™Ǧ—’’‡”‹‘†‘ˆʹͶ ™‡‡•ȋ͸‘–Š•Ȍǡ‘„‹Ž‹–›†‹•ƒ„‹Ž‹–‹‡•„‡‹‰–Š‡•‡ ‘†™‘”•‡ȋˆ‹‰—”‡Ͷƒ†ͷȌǤ Figure4:‡” ‡–ƒ‰‡•‘ˆ‹ Ž—†‡†’ƒ–‹‡–•”‡’‘”–‹‰pain. . ʹͷ.

(105) DaySurgery____________________________________________________________________________________. Figure5:‡” ‡–ƒ‰‡•‘ˆ‹ Ž—†‡†’ƒ–‹‡–•”‡’‘”–‹‰mobilityproblems. Š‡™‡ƒƒŽ›•‡†–Š‡•‡ŽˆǦƒ••‡••‡†“—‡•–‹‘ƒ‹”‡•™‡ˆ‘—†–Šƒ––Š‡”‡ ‘˜‡”› ’”‘ˆ‹Ž‡†‹ˆˆ‡”‡†„‡–™‡‡–Š‡’”‘ ‡†—”‡••–—†‹‡†Ǥ Š‡ˆ‘ŽŽ‘™‹‰‹†‹˜‹†—ƒŽ’ƒ–‹‡–†ƒ–ƒǡ‹–™ƒ•ˆ‘—†–Šƒ–’”‡‘’‡”ƒ–‹˜‡’ƒ‹™ƒ• ƒ••‘ ‹ƒ–‡†™‹–Šƒ•‹‰‹ˆ‹ ƒ–Š‹‰Š‡””‹•ˆ‘”’ƒ‹ƒŽ•‘ƒ–ƒ†ƒˆ–‡”‘‡ ’‘•–‘’‡”ƒ–‹˜‡™‡‡ȋ•–—†›

(106)

(107)

(108) ȌǤ ‡ƒŽ•‘ˆ‘—†–Šƒ–’ƒ–‹‡–•™‹–Š”‡ƒ‹‹‰’ƒ‹ƒˆ–‡”͵Ͳ†ƒ›•Šƒ†ƒ†‹ˆˆ‡”‡– ’”‡‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š’”‘ˆ‹Ž‡ǡ‡•’‡ ‹ƒŽŽ›‡˜‹†‡–ˆ‘”’ƒ–‹‡–•‹–Š‡‰”‘—’ȋ–ƒ„Ž‡ͺȌǤ ‘ŽŽ‘™Ǧ—’ƒ–͵Ͳ†ƒ›•”‡˜‡ƒŽ–Šƒ–ͳͻΨȋ͸͹Ȁ͵ͷͷȌ‘ˆ–Š‡’ƒ–‹‡–•”‡’‘”–‡†•—”‰‡”› ”‡Žƒ–‡†’ƒ‹ǤŠ‡ƒƒŽ›•‹‰–Š‹•‰”‘—’ǡ‘Ž›’”‡‘’‡”ƒ–‹˜‡’ƒ‹ƒ‘‰’ƒ–‹‡–• •Š‘™‡†ƒ•‹‰‹ˆ‹ ƒ–ƒ••‘ ‹ƒ–‹‘™‹–Š’ƒ‹ƒˆ–‡”͵Ͳ†ƒ›•Ǥ”‡‘’‡”ƒ–‹˜‡†‡’”‡••‹‘ǡ ƒƒŽ‰‡•‹ —•‡ǡ‹‘„‹Ž‹–›‘”ˆ‡ƒŽ‡‰‡†‡”ǡ™‡”‡‘–ˆ‘—†–‘„‡ƒ••‘ ‹ƒ–‡†–‘ •—”‰‡”›”‡Žƒ–‡†’ƒ‹ƒ––Š‡͵ͲǦ†ƒ›ˆ‘ŽŽ‘™Ǧ—’Ǥ Table 8: Number of patients with pain at 30 days and their preoperative profile IHR Pain at 30 d Preoperative pain sign Preoperative depression sign Preop. analgesic use Preop. immobilization Female gender. ʹ͸ . AS 12 9. p=0.2058. CBA 41 33. p=0.0075** 5. p=0.2042. 67 44. 1. 16. 1 1 14. 20 30 40. p=0.1709 10. p=0.8051 4 8 3. Total 14 2. p=0.6088 15 21 23.

(109) . ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴. Results.  ŽŽ•—”‰‡”›”‡Žƒ–‡†•›’–‘•ǡ’ƒ‹ǡ‹‘„‹Ž‹–›ǡ†‡’”‡••‡†‘‘†ǡ†‹•–—”„ƒ ‡•‹•‡ŽˆǦ ƒ”‡ǡƒ –‹˜‹–›ǡ•Ž‡‡’‘”•‡š—ƒŽˆ— –‹‘ƒ†ƒƒŽ‰‡•‹ —•‡™‡”‡ƒ††‡†–‘‰‡–Š‡”ƒ†–Š‡ •—™ƒ• ƒŽŽ‡†̶†‹• ‘ˆ‘”–‘ˆƒ›‹†̶Ǥ Figure6:”‘’‘”–‹‘•‘ˆ’ƒ–‹‡–•”‡’‘”–‹‰•—”‰‡”›”‡Žƒ–‡††‹• ‘ˆ‘”–‘ˆƒ›‹†ƒ– ͳǡ͵ƒ†͸‘–Š•ǡΨ‘ˆƒŽŽ’ƒ”–‹ ‹’ƒ–•‹ Ž—†‡†. Š‡‡†Ǧ’‘‹–Ǣ™Š‡’ƒ–‹‡–•™‡”‡ˆ—ŽŽ›”‡ ‘˜‡”‡††‹ˆˆ‡”‡†ƒ‘‰–Š‡’”‘ ‡†—”‡•Ǥ

(110) ƒ†’ƒ–‹‡–•ˆ‘ŽŽ‘™‡†–Š‡•ƒ‡’ƒ–Š‘ˆ”‡•–‹–—–‹‘ƒŽ–Š‘—‰Š–Š‡•–ƒ”–‹‰ ’‘‹–•™‡”‡‘–‹†‡–‹ ƒŽǤŠ‡’ƒ–‹‡–‰”‘—’•Š‘™‡†ƒ•Ž‘™‡””‡•–‹–—–‹‘‘ˆ •›’–‘•ǡ™Š‡ƒ•™‡”‹‰ǡDz†‘›‘—ˆ‡‡Žƒ›•—”‰‡”›”‡Žƒ–‡††‹• ‘ˆ‘”–‘ˆƒ› ‹†dzǫȋˆ‹‰—”‡͸ȌǤ. . ʹ͹.

(111) DaySurgery____________________________________________________________________________________. StudyV

(112) –Š‹• ‹–‡”˜‡–‹‘•–—†› ‘’ƒ”‹‰–Š‡•‡Ž‡ –‹˜‡ ‘š‹„‡–‘”‹ ‘š‹„ƒ†–”ƒƒ†‘Ž ƒˆ–‡”ŠƒŽŽ—š˜ƒŽ‰—••—”‰‡”›ǡ’ƒ‹”‡Ž‹‡ˆ†—”‹‰–Š‡ˆ‹”•–’‘•–‘’‡”ƒ–‹˜‡™‡‡™ƒ•ˆ‘—† –‘„‡„‡––‡”‹–Š‡‡–‘”‹ ‘š‹„‰”‘—’–Šƒ‹–Š‡–”ƒƒ†‘Ž‰”‘—’Ǥ ‘”‡†ƒš‹ƒŽ’ƒ‹ ™ƒ•Š‹‰Š‡”‹–Š‡–”ƒƒ†‘Ž‰”‘—’†—”‹‰–Š‡ˆ‹”•–’‘•–‘’‡”ƒ–‹˜‡™‡‡ȋˆ‹‰—”‡ʹ‹ •–—†›ȌǤ

(113) –ƒ„Ž‡ͻǡ’ƒ‹”ƒ–‹‰•ƒ•‡ƒ• ‘”‡ƒ”‡’”‡•‡–‡†ˆ‘”–Š‡‡–‹”‡ ‰”‘—’Ǥ Table9:ƒ‹ƒ–†‹ˆˆ‡”‡––‹‡’‘‹–•ˆ‘”ƒŽŽ ’ƒ–‹‡–•αͻͺȋ‡ƒƒ–ǡ ƒˆ–‡”ͳ†ƒ›ƒ†ͳ™‡‡ǡΨ‘ˆ’ƒ–‹‡–•‹’ƒ‹ƒˆ–‡”ͳ͸™‡‡•Ȍ PACU Day 1 1 week 16 weeks. Mean VAS / pain % 2.1 3.2 2.0 19 % of patients. ‡ˆ‘—†–Šƒ–’ƒ–‹‡–•ƒ–‹•ˆƒ –‹‘™ƒ•„‡––‡”ǡͶ͹ȀͶͻ‹–Š‡‡–‘”‹ ‘š‹„‰”‘—’ǡ ‘’ƒ”‡†–‘͵ͻȀͶͻ‹–Š‡–”ƒƒ†‘Ž‰”‘—’ǤŠ‡”‡™‡”‡ˆ‡™ƒ†˜‡”•‡‡˜‡–•Ǥ‹†‡ ‡ˆˆ‡ –•™‡”‡”‡’‘”–‡†ˆ”‘ͺ’ƒ–‹‡–•‹–Š‡‡–‘”‹ ‘š‹„‰”‘—’ƒ†ˆ”‘͵ͷ’ƒ–‹‡–•‹ –Š‡–”ƒƒ†‘Ž‰”‘—’ȋ–ƒ„Ž‡͵‹•–—†›ȌǤƒ–‹•ˆƒ –‹‘”ƒ–‡™‹–Š’ƒ‹ƒƒ‰‡‡–™ƒ• ͺͺΨ‘ˆ’ƒ–‹‡–•Ǥ‘‹’ƒ‹”‡†Š‡ƒŽ‹‰‘” ƒ”†‹ƒ ƒ†˜‡”•‡‡˜‡–•™‡”‡‘–‡†‹ ’ƒ–‹‡–•ǯƒ••‡••‡†‘—– ‘‡ƒ–ͳ͸Ǧ™‡‡ˆ‘ŽŽ‘™Ǧ—’ȋ–ƒ„Ž‡Ͷƒ†ͷ‹’ƒ’‡”ȌǤ ƒ–‹‡–•• ‘”‡†–Š‡‹”“—ƒŽ‹–›‘ˆŽ‹ˆ‡’”‹‘”–‘•—”‰‡”›ƒ†ƒˆ–‡”ͳ͸™‡‡•Ǥ‹ ”‡ƒ•‡† • ‘”‡™ƒ•ˆ‘—†‹„‘–Š‰”‘—’•„—–‘–•‹‰‹ˆ‹ ƒ–„‡–™‡‡‰”‘—’•‘”„‡–™‡‡–‹‡ ’‘‹–•ȋ–ƒ„Ž‡ͳͲȌǤŽ•‘’ƒ‹”‡Ž‹‡ˆ• ‘”‡†‹Ψ™‹–Šƒƒš‹—‘ˆͳͲͲΨ‡ˆˆ‡ –‹˜‡‡•• ‹••Š‘™‹–ƒ„Ž‡ͳͳǤƒ‹”‡Ž‹‡ˆ™ƒ•Š‹‰Š‹„‘–Š‰”‘—’•™‹–Šƒ‹ ”‡ƒ•‡†‡ƒ’ƒ‹ ”‡Ž‹‡ˆ• ‘”‡†ƒ›ͳǦ͹‹–Š‡‡–‘”‹ ‘š‹„‰”‘—’Ǥƒš‹ƒŽ’ƒ‹• ‘”‡†—”‹‰–Š‡ ’‡”‹‘†ǡ•Š‘™‡†ƒ’‡ƒ‘†ƒ›ʹƒ†͵ǡ™‹–Šƒ‡ƒ• ‘”‡•‹‰‹ˆ‹ ƒ–Ž‘™‡”ˆ‘”–Š‡ ‡–‘”‹ ‘š‹„‰”‘—’ ‘’ƒ”‡†–‘–Š‡–”ƒƒ†‘Ž‰”‘—’Ǥ Table 10: QoL VAS score in %. Quality of life VAS score from EQ-5D (1-100) etoricoxib Preoperatively After 16 weeks. ʹͺ . tramadol 88 94. p 92 ns 95 ns.

(114) . ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴. Results. Table11:ƒ‹”‡Ž‹‡ˆˆ”‘•–—†›‡†‹ ƒ–‹‘• ‘”‡ȋͲǦͳͲͲΨ‡ˆˆ‡ –‹˜‡Ȍ . . etoricoxib. tramadol. ȋαͶͻȌ. ȋαͶͻȌ. ƒ‹”‡Ž‹‡ˆƒ›ͳ. ͻͲάͳ͵. ͺ͸άͳ͵. •. ƒ‹”‡Ž‹‡ˆƒ›ʹ. ͺͷάͳ͹. ͹ͺάͳͺ. ’αͲǤͲͶͷͶ. ƒ‹”‡Ž‹‡ˆƒ›͵. ͺͻάͳ͸. ͺͲάʹͲ. ’αͲǤͲͳͶ͵. ƒ‹”‡Ž‹‡ˆ†ƒ›Ͷ. ͻ͵άͳʹ. ͺ͹άͳ͹. •. ƒ‹”‡Ž‹‡ˆƒ›ͷ. ͻͶάͳͳ. ͺ͹άͳͻ. ’αͲǤͲͶ͹ʹ. ƒ‹”‡Ž‹‡ˆƒ›͸. ͻͶάͳͳ. ͻͲάͳ͹. •. ƒ‹”‡Ž‹‡ˆƒ›͹. ͻ͵άͳͶ. ͺͻάͳͻ. •. . . . ͻʹǤͲάͳͳǤͺ. ͺͷǤͶάͳͶǤͻ. ’αͲǤͲͶͲʹ. . . . ͹. ͳͷ. •. . . . ͳǤͺάͳǤʹ. ʹǤͷάͳǤ͸. ’αͲǤͲͳͺ. ‡ƒƒ‹”‡Ž‹‡ˆ• ‘”‡ ƒ›ͳǦ͹‡ƒƒšη͵ƒ– ƒ›–‹‡†—”‹‰–Š‡͹Ǧ†ƒ› ‡†‹ ƒ–‹‘’‡”‹‘†ȋ‘Ǥ‘ˆƒ–ǤȌ. ‡ƒƒš’ƒ‹• ‘”‡ƒ› ͳǦ͹. ns: non-significant difference between study groups. . ʹͻ.

(115) DaySurgery____________________________________________________________________________________. Summary –—†›

(116) •Š‘™‡†–Šƒ–™‡†‹•Š‹•‹ ”‡ƒ•‹‰ƒ†”‘—–‹‡•ƒ”‡•‹‹Žƒ”„‡–™‡‡ Š‘•’‹–ƒŽ•„—––Šƒ–ˆ‘ŽŽ‘™Ǧ—’”‘—–‹‡•†‹ˆˆ‡”ǤŠ‡†—”ƒ–‹‘‘ˆˆ‘ŽŽ‘™Ǧ—’˜ƒ”‹‡•„‡–™‡‡ Š‘•’‹–ƒŽ•ǡ„—–‹• ‘•‹•–‡–Ž›•Š‘”–Ǥ –—†›

(117)

(118) ‹˜‡•–‹‰ƒ–‹‰–Š‡ˆ‹”•–™‡‡ƒˆ–‡”͵ ‘‘’”‘ ‡†—”‡•ǡ•Š‘™‡†–Šƒ––Š‡ ’”‡‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š’”‘ˆ‹Ž‡‹•‹’‘”–ƒ–‹’”‡†‹ –‹‰‡ƒ”Ž›”‡ ‘˜‡”›ǡ’ƒ”–‹ —Žƒ”Ž› ƒ—•‡ƒƒ†’ƒ‹ǤŠ‹••–—†›ƒŽ•‘ˆ‘ —•‡†‘–Š‡”‡ƒ•‘ˆ‘”‹ ‘–‹‡—•‡”•–‘‡šŠ‹„‹–ƒ Ž‘™‡”‹ ‹†‡ ‡‘ˆƒ—•‡ƒǤ –—†›

(119)

(120)

(121) ǡƒ††”‡••‹‰–Š‡’ƒ–‹‡–•ǯ•‡ŽˆǦƒ••‡••‡†ˆ‘ŽŽ‘™Ǧ—’‘ˆ•›’–‘•†—”‹‰Ͷ ™‡‡•ƒˆ–‡”•—”‰‡”›ǡ•Š‘™‡††‹ˆˆ‡”‡ ‡•‹–Š‡”‡ ‘˜‡”›’”‘ ‡••„‡–™‡‡†‹ˆˆ‡”‡– •—”‰‹ ƒŽ’”‘ ‡†—”‡•ǤŠ‡”‡•—Ž–•‘ˆ–Š‹••–—†›ƒŽ•‘—†‡”Ž‹‡†–Šƒ–ƒŽŽ’ƒ–‹‡–•™‡”‡ ‘–ˆ—ŽŽ›”‡ ‘˜‡”‡†Ͷ™‡‡•ƒˆ–‡”Ǥ –—†›

(122) ǡƒ͸Ǧ‘–Šˆ‘ŽŽ‘™Ǧ—’‘ˆ–Š‡’‘•–‘’‡”ƒ–‹˜‡Š‡ƒŽ–Š’”‘ˆ‹Ž‡ǡ•Š‘™‡††‹ˆˆ‡”‡– ’”‘ ‡†—”‡•’‡ ‹ˆ‹ ”‡•–‹–—–‹‘ƒ†–Šƒ––Š‡”‡“—‹”‡†ˆ‘ŽŽ‘™Ǧ—’–‹‡†‹ˆˆ‡”‡†„‡–™‡‡ •—”‰‹ ƒŽ’”‘ ‡†—”‡•Ǥ –—†›ǡƒͳ͸Ǧ™‡‡’ƒ‹‹–‡”˜‡–‹‘•–—†›ǡ•Š‘™‡†–Šƒ–‡–‘”‹ ‘š‹„™ƒ•‘”‡ ‡ˆˆ‡ –‹˜‡‹ ‘–”‘ŽŽ‹‰’ƒ‹ƒ†™‹–Šˆ‡™‡”•‹†‡‡ˆˆ‡ –•–Šƒ–”ƒƒ†‘Žƒˆ–‡”ŠƒŽŽ—š ˜ƒŽ‰—••—”‰‡”›Ǥ. ͵Ͳ .

References

Download now ( PDF - 63 Page - 7.28 MB )

Related documents

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Negativ påverkan.Positiv påverkan. Ingen BerörsStorMåttligLitenLitenMåttligStorpåv.ejKommentarer BehovsbedömningPlan: Del av Kvarnarna 2:1 (Östra Torg) i Ljungby tätor

Där bostadsbebyggelsen ska stå kommer det att bli en hårddjord yta, men det kommer bli mer växtlighet på den resterande ytan, eftersom planbestämmelsen ändras från torg till

|x − 1| 2− 3|x − 1| + 2 < 0 (Svar: {x ∈ R: − 1 < x < 0} ∪ {x ∈ R: − 2 < x < 3}) 2823. Visa att om x > y > 1 så är x y − 1 > x − y > ln(x/y).

2845.. Ett av nedanstående alternativ är det rätta värdet. a) Ange en följd av 10 konsekutiva positiva heltal som inte inne- håller något primtal... b) Visa att för varje

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X*** X X X X X X X X X X X X X X X X X X X

13 kap 10 § - Beslut om förvärv eller överlåtelse av den omyndiges fasta egendom eller nyttjanderätt till sådan egendom ävensom upplåtande av nyttjanderätt, panträtt m.m..

(1)Ansökningsn ummer Intervjutid Intervjurum 3211517X X X X X X X X X X X X X X X X X X X X X X X X X X X 15.10 211

[r]

Skötselplan för planerad avloppsanläggning på fastigheten:________________ X X X X X X X X X X

Inga buskar, träd eller övriga växter med djupgående rötter växer på infiltration Infiltration har ej belastats och belastas ej av fordon, stora djur (kor, hästar), eller

Skötselplan för planerad avloppsanläggning på fastigheten:________________ X X X X X X X X X X

Inga buskar, träd eller övriga växter med djupgående rötter växer på markbädd Markbädd har ej belastats och belastas ej av fordon, stora djur (kor, hästar),

Delegationsordning. Kultur- och utbildningsnämnden 2019-x-x x

utbildning i svenska för invandrare Rektor SL 20:33 Beslut kan överklagas till Skolväsendets överklagande-

= för övrigt x x kx

(4p) Man vill jämföra två metoder för mätning av en vis variabel som anses normalfördelad med okänd standardavvikelse. Svar: Eftersom 0 ligger i intervallet kan vi INTE påstå