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Cabaton J, Thy M, Sciard D, De Paulis D, Beaussier M. Unplanned admission after ambulatory anaesthesia in France: analysis of a database of 36,584 patients. Anaesth Crit Care Pain Med 2020; 40:100794. [PMID: 33359372 DOI: 10.1016/j.accpm.2020.100794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Unplanned admission (UA) after ambulatory procedures is an unexpected event that has organisational and financial impacts. This study was undertaken to determine the current rate of UA in France and to evaluate the factors associated with the occurrence of this event. METHOD This is a retrospective analysis of a database of 36,584 patients issued from a private hospital in France. This study received an IRB approval. All of the patients that received ambulatory anaesthesia between April 2015 and June 2017 were included in this database. RESULTS The overall rate of UA was 1.8% (95%CI: 1.3-2.3]. Hospitalisation after endoscopic procedures (gastrointestinal endoscopy and bronchial fibroscopy) was 1.1% (95%CI: 0.3-1.9), whereas it was 2.5% (95%CI: 1.8-3.2) after surgical procedures (p < 0.01). Organisational concerns, medical reason and surgical complications accounted respectively for one third of the hospitalisations. Pain was liable in 13% of cases, whereas PONV, residual sedation and urinary retention accounted respectively for 6.9%, 2.8% and 2.6% of cases. In a multivariate analysis, age > 60 years, ASA status > 2, general anaesthesia and the type of the procedures were identified risk factors. CONCLUSIONS In this large cohort of ambulatory patients, the rate of UA remains significant. This is probably related, at least partly, to more invasive procedures scheduled in ambulatory setting. However, organisational problems occurred still frequently. Some factors appear to be easily improvable by appropriate preoperative information, better operating theatre scheduling and better analgesic strategy.
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Affiliation(s)
- Julien Cabaton
- Department of Anaesthesiology, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Michael Thy
- Department of Anaesthesiology, Institut Mutualiste Montsouris, Paris, France
| | - Didier Sciard
- Department of Anaesthesiology, Institut Mutualiste Montsouris, Paris, France
| | - Damien De Paulis
- Department of Anaesthesiology, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Marc Beaussier
- Department of Anaesthesiology, Institut Mutualiste Montsouris, Paris, France.
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Albaladejo P, Aubrun F, Samama CM, Jouffroy L, Beaussier M, Benhamou D, Romegoux P, Skaare K, Bosson JL, Ecoffey C. The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study. Anaesth Crit Care Pain Med 2016; 36:307-312. [PMID: 27913269 DOI: 10.1016/j.accpm.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/12/2016] [Accepted: 10/04/2016] [Indexed: 11/16/2022]
Abstract
The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013-2014, the French society of anaesthesia and intensive care organized an extensive practical survey in French ambulatory surgery units entitled the "OPERA" study (Organisation periopératoire de l'anesthésie en chirurgie ambulatoire). From among all of the ambulatory surgery centres listed by the Agences régionales de santé (Regional health agencies, France), 206 public and private centres were randomly selected. A structural (typology, organization) survey and a medical-practice survey (focusing on the management of postoperative pain, nausea and vomiting as well as the prevention of venous thromboembolism) were collected and managed by a prospective audit of practices occurring on two randomly selected days. The latter was further accompanied by an additional audit specifically focussing on ten representative procedures: (1) stomatology surgery (third molar removal); (2) knee arthroscopy; (3) surgery of the abdominal wall (including inguinal hernia); (4) perianal surgery; (5) varicose vein surgery; (6) digestive laparoscopy-cholecystectomy; (7) breast surgery (tumourectomy); (8) uterine surgery; (9) hallux valgus and (10) hand surgery (excluding carpal tunnel). Over the 2 days of observation, 7382 patients were included comprising 2174 patients who underwent one of the procedures from the above list. The analysis of these data will provide an overview of the organization of health establishments, the modalities thus supported and compliance with standards.
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Affiliation(s)
- Pierre Albaladejo
- Department of anaesthesia and intensive care, Grenoble university hospital, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France; Clinical investigation centre, Grenoble university hospital, ThEMAS, TIMC, UMR-CNRS 5525, university Grenoble-Alpes, 38700 La Tronche, France.
| | - Frédéric Aubrun
- Department of anaesthesiology and intensive care, hospices civils de Lyon, La-Croix-Rousse university hospital, 69004 Lyon, France
| | - Charles-Marc Samama
- Department of anaesthesiology and intensive care, Assistance publique-Hôpitaux de Paris, Cochin university hospital, 75014 Paris, France
| | | | - Marc Beaussier
- Department of anaesthesiology and intensive care, Assistance publique-Hôpitaux de Paris, Saint-Antoine university hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Dan Benhamou
- Department of anaesthesiology, hôpital Bicêtre, groupe hospitalier, faculté de médecine Paris Sud, AP-HP, 78, rue du Général-Koenig, 94270 Le Kremlin-Bicêtre, France
| | - Pauline Romegoux
- Clinical investigation centre, Grenoble university hospital, ThEMAS, TIMC, UMR-CNRS 5525, university Grenoble-Alpes, 38700 La Tronche, France
| | - Kristina Skaare
- Clinical investigation centre, Grenoble university hospital, ThEMAS, TIMC, UMR-CNRS 5525, university Grenoble-Alpes, 38700 La Tronche, France
| | - Jean-Luc Bosson
- Clinical investigation centre, Grenoble university hospital, ThEMAS, TIMC, UMR-CNRS 5525, university Grenoble-Alpes, 38700 La Tronche, France
| | - Claude Ecoffey
- Department of anaesthesiology and intensive care, Rennes university hospital, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
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