[Breast cancer and outpatient surgery: State of play of the activity and assessment of patient satisfaction]

OBJECTIVE

The objective of this study was to evaluate an outpatient breast cancer surgery activity in our center and to collect the satisfaction of patient having benefited.

METHOD

Descriptive and retrospective study about patients who underwent surgery for breast cancer scheduled on ambulatory between March 2015 and March 2017. Patients' satisfaction was collected retrospectively by a questionnaire.

RESULTS

Six hundred and thirty-nine breast cancer surgeries were performed during the study period, of which 56.2% were scheduled for outpatient surgery: 33 axillary procedures (9.2%), 289 conservative surgeries (80.5%) and 37 radical surgeries (10.3%). Forty-nine patients initially managed on ambulatory had to be hospitalized on conventional service, representing a conversion rate of 13.6%. The main reason was the establishment of drainage (30.6%). The complication rate was 0.6% with 2 patients rehospitalized for hematoma requiring surgical revision. Of the 359 patients treated on ambulatory, 61% responded to the satisfaction questionnaire. Overall satisfaction was 96.3%. In addition, 68.3% of patients said they had seen a real benefit in this mode of care. After returning home, 59,8% of patients reported feeling no or low pain.

CONCLUSION

Outpatient management seems to be both safe and satisfying for breast cancer surgery. A better organization of patient going home is in progress in order to reduce rate of conversion.

Outpatient paediatric arthroscopy: A retrospective study in 216 Patients

BACKGROUND

Outpatient surgery is now widely performed in adults but remains rarely used for paediatric orthopaedic procedures. As with adult surgery, both the arthroscopic equipment and anaesthesia techniques have improved over the last few years. Arthroscopy is particularly well advanced at the knee but can also be used at other joints (hip, ankle, elbow, shoulder). The primary objective of this study was to evaluate the feasibility of outpatient paediatric arthroscopy.

HYPOTHESIS

Arthroscopic surgery can be performed in children on an outpatient basis provided an appropriate care programme is applied.

MATERIALS AND METHODS

This single-centre retrospective study included 216 patients aged 3.8 to 18 years who underwent outpatient arthroscopy (knee, n=170; ankle, n=22; elbow, n=12; shoulder, n=6; and hip, n=6). The decision to perform the procedure on an outpatient basis was made with the patient during the surgeon visit then confirmed during the anaesthesiologist visit. The main outcome measure was failure of outpatient arthroscopy defined as a need for standard inpatient admission. The secondary outcome measures were pain or sleep disturbances on the day after the procedure (as assessed during a telephone call), a need to see a physician during the first week after the procedure, and patient satisfaction.

RESULTS

Of the 216 patients, 9 required overnight admission (4 because of vomiting, 4 because of pain, and 1 because of a malaise) and 2 patients were admitted elsewhere for postoperative pain then discharged within 24hours. Of the 160 patients who could be contacted on the day after the procedure, 141 (88%) said they had had a good night and 141 (88%) that they had little or no pain. Over 95% of patients were satisfied with their outpatient management.

DISCUSSION

As with adults, arthroscopic surgery is an ideal indication for outpatient care in paediatric patients. Outpatient arthroscopic surgery is already widely used at the knee and is also suitable for other joints in the paediatric population.

LEVEL OF EVIDENCE

IV, retrospective study.

[Perception of health care quality by patients with chronic conditions]

BACKGROUND

Patient opinion is becoming ever more important when considering healthcare quality and the reforms required to improve healthcare quality. The main aim of this study was to explore factors determining perceived healthcare quality among patients with chronic diseases.

METHODS

Data are drawn from the survey carried out in 2008 by the Commonwealth Fund, in partnership with the French Superior Health Authority (Haute Autorité de santé). The prospective telephone survey targeted adults in eight countries who had serious health problems (chronic or severe disease, declared poor state of health, hospital admission or major surgery). Of the 1202 French respondents, 851 had at least one diagnosed chronic disease. A multinomial logistic model was used to identify the relationship between perceived healthcare quality and patients' recent experience with the healthcare system.

RESULTS

People with chronic disease in general perceived that healthcare quality was excellent (45%) or good (44%). Only 11% of respondents judged it to be average or poor. There was a hint of "could do better", for example when considering podology and ophthalmology follow-up in diabetes or the management of multiple medications. The explanatory model revealed a positive correlation between excellent perceived healthcare quality and a strong doctor-patient relationship, taking into account both the length of this relationship and the ability of the doctor to involve the patient at all stages of decision-making concerning therapeutic management. There was no major link between the perceived quality of care and objective care quality, the quality of procedures, the cost of care to the patient or how frequently patients access the healthcare system.

CONCLUSION

The quality of the relationship between the patient and his/her doctor is a determining factor in the patient's judgement of the quality of healthcare he/she receives.