Abstract: Key points and difficulties of day surgery for varicose veins of lower extremities        ZHU Yue-feng*, TANG Ming-jun. *International Institutes of Medicine, Zhejiang University;Sir Run Run Shaw Hospital, Zhejiang University School of Medicine;The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
Corresponding author: ZHU Yue-feng,E-mail:srrshzyf@zju.edu.cn
Abstract    Day surgery is a kind of surgery that benefits the country, the hospital, and the patient. It has created a new mode of medical service, and has the advantages of reasonable optimization of resources, effective cost saving, easing the contradiction of hospital admission, and saving patients' expenses. China has introduced a series of policies to promote day surgery, with lower limb varicose veins being among the first batch of day surgery procedures. Currently, deficiencies in the medical insurance settlement system lead patients to forgo minimally invasive treatments, increasing individual and societal costs. Reforming the payment system based on diagnosis-related groups (DRG) is conducive to controlling medical insurance expenses, enhancing patient treatment outcomes, and improving the overall patient experience. While European and American countries widely adopt minimally invasive surgery for treating lower limb varicose veins, many regions in China still rely on traditional stripping surgery. Minimally invasive surgery offers advantages such as minimal trauma, swift recovery, and fewer complications, making it suitable for the day surgery model. Day surgery requires coordination among multiple departments, standardizing outpatient procedures, examination processes, and inpatient protocols. Quality control for day surgery should encompass rigorous preoperative diagnosis, scientific surgical planning, and standardized perioperative management. After day surgery, patients might encounter various medical conditions, necessitating follow-up visits to assess their condition and conduct satisfaction surveys. Additionally, patients need to receive health education, including guidance on precautions and recommendations at different time intervals.

Key words: day surgery, varicose veins, payment by disease diagnosis-related group

摘要： 日间手术是一种能使国家、医院和病人三方均受益的模式，其开创了医疗服务的新模式，具有合理优化资源、有效节省成本、缓解住院难矛盾、节省病人开支的优势。我国出台了一系列推动日间手术的政策，下肢静脉曲张是首批日间手术病种之一。目前，医保结算方式存在不足，导致病人放弃微创疗法，增加个人和社会成本。基于疾病诊断相关分组(DRG)的支付制度改革有利于控制医保费用，提升病人治疗效果和就医体验。欧美国家已经广泛采用微创手术治疗下肢静脉曲张，而我国大部分地区仍然停留在传统的剥脱手术。微创手术具有创伤小、恢复快、并发症少等优点，适合日间手术模式。日间手术需要多部门协调，规范门诊流程、检查流程和住院流程。日间手术质控需要从严谨的术前诊断、科学的手术方案设计、规范的围手术期管理等方面进行。日间手术后病人还有可能发生很多医疗状况，需要通过随访了解病人情况，并进行满意度调查。同时，需要对病人进行健康宣教，指导病人知晓围手术期的各种注意事项。

关键词: 日间手术, 下肢静脉曲张, 按疾病诊断相关组付费