Day surgery: Results after restructuration of a university public general surgery unit - 13/04/13

Doi : 10.1016/j.jviscsurg.2013.03.002

S. Gaucher ^a,^b,^c,^⁎ , F. Cappiello ^a,^b, S. Bouam ^d, I. Damardji ^b, A. Aissat ^b,^c, I. Boutron ^a,^e, J.P. Béthoux ^a,^b,^c
^a Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
^b Service de chirurgie générale, plastique et ambulatoire, AP–HP Hôtel Dieu, 75004 Paris, France
^c Service de chirurgie générale, plastique et ambulatoire, AP–HP Cochin Port-Royal, 53, avenue de l’Observatoire, 75014 Paris, France
^d Département d’information médicale, AP–HP Hôtel-Dieu, 75004 Paris, France
^e Centre d’épidémiologie clinique, AP-HP Hôtel-Dieu, 75004 Paris, France

^*Corresponding author. Service de chirurgie générale, plastique et ambulatoire, AP–HP Cochin Port-Royal, 53, avenue de l’Observatoire, 75014 Paris, France. Tel.: +33 1 58 41 15 37; fax: +33 1 58 41 38 77.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 13 April 2013
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Summary

Introduction

Nowadays, in France, development of the ambulatory surgery has stalled. This is probably related to the fact that ambulatory surgery is restricted by the law to the “day surgery” in 12 hours, and only 17 procedures are referenced for this surgery. Thus, conventional hospitalization remained the rule after surgery. In January 2010, our university general surgery unit was restructured. It evolved from a conventional unit to a predominantly ambulatory unit. Otherwise, our unit adjoins a hotel, even inside our institution, which accommodates patients, patient visitors and tourists.

Aim

The aim of this retrospective study was to compare the postoperative accommodation modalities between two groups of patients. The first group consisted of patients admitted before January 2010, at the time of conventional activity, whereas the second group consisted of patients admitted after January 2010 in a restructured unit.

Methods

Inclusion of patients admitted from April 1, 2008 to March 31, 2009 (conventional hospitalization period) and from April 1, 2010 to March 31, 2011 (ambulatory management period), scheduled for one single surgical procedure excluding emergency.

Results

A total of 360 patients were retained: 229 for the conventional period and 131 for the ambulatory period, with a median age of 55 (range 15–87). No statistically significant difference was noted between the two groups as concerned median age, gender or ASA status. The number of postoperative nights varied significantly between the two groups with a mean of 3.8 nights (median three nights, range 0–32) for the conventional period versus 0.4 nights (median 0 night, range 0–10) for the ambulatory period (P<0.0001 by the unadjusted Mann-Whitney test and P<0.0001 by the Wald test [with adjustment]).

Discussion

Our results show that it is clearly possible to distinguish the need for care of the need for accommodation and significantly reduce postoperative conventional accommodation. They also raise the question of extending the legal period of 12 hours to 24 hours in order to expand the list of the referenced procedures

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Keywords : One-day surgery, Day surgery, Conventional surgery, Patient hotel

Plan

Disclosure of interest

This paper has been previously presented at: Académie Nationale de Chirurgie, Paris, 11th January 2012; 3rd Journée Nationale de Chirurgie Ambulatoire (JAB), Paris, 11th January 2012.