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International survey and consensus (ICON) on ambulatory surgery in rhinology - 21/02/18

Doi : 10.1016/j.anorl.2017.12.010 
L. de Gabory a, b, , L.J. Sowerby c, J.M. DelGaudio d, A. Al-Hussaini e, C. Hopkins f, E. Serrano g
a ENT department, University Hospital of Bordeaux, Pellegrin Hospital, F-X Michelet Center, 33076 Bordeaux, France 
b University of Bordeaux, 33000 Bordeaux, France 
c ENT department, Schulich School of Medecine and dentistry, London, Ontario, Canada 
d ENT department, Emory University, 30322 Atlanta, GA, United States of America 
e ENT department, University Hospital of Wales, Cardiff, United Kingdom 
f ENT department, Guy's and Saint-Thomas’ Hospital, London, United Kingdom 
g ENT department, University Hospital Rangueil-Larrey, Toulouse, France 

Corresponding author at: Department of Rhinology and Plastic Surgery, Centre F-X Michelet, C.H.U. de Bordeaux, Place Raba-Léon, 33075 Bordeaux, France.

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Abstract

Objectives

Day-case surgery is the gold standard to several surgical procedures in Rhinology. However, few data and guidelines have been published except in the Anglo-Saxon countries and France. The aim of this survey was to propose a list of issues arising during day-case surgery in order to analyze the different constraints encountered around the world.

Material and method

It was a prospective multicenter international email survey. The method was based on the formalized expert consensus methodology. A list of 11 issues was based on literature data and was sent by e-mail to 265 key opinion leaders (KOL) who attended the IFOS congress.

Results

The response rate was 20% from 27 countries without statistical difference between continents concerning the score on each item. The mean age of KOL was 50±10 years. Their mean length of experience was 21±10 years. Issues in relation with technical resources and experience showed that the last time at which ambulatory surgery in the day is possible was 4:00 PM but responses varied depending the availability of technical resources. Bleeding or hematoma occurred most frequently between the third and fourth postoperative day whatever the surgical procedure. A strong agreement and consensus was obtained concerning the nasal packing, septal contention and their schedule of removal which were not a contraindication of day-case. Also 75% of participants were agreeing with a therapeutic education program to improve the performance of postoperative care and decrease readmission rates. A relative agreement without consensus were obtained for the distance between the day-case unit and home, the role of surgery duration and the impact of anticoagulant and/or antiplatelet drugs in overnight admission and readmission rates.

Conclusion

Practice varies widely owing to local organization constraints and the availability of a dedicated day-case unit seems to be the main limiting factor.

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Keywords : Rhinology, Sinus surgery, International consensus, Day-case surgery, Ambulatory care


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Vol 135 - N° 1S

P. S49-S53 - février 2018 Retour au numéro
Article précédent Article précédent
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