An intervention to treat a thyroid, certain breast cancers, a knee, a shoulder, a fracture … it can now take place over a single day. In 2013, 42.7% of operations were thus performed on an outpatient basis. Abroad, more than eight out of ten procedures are carried out in this way. Last July, the Haute Autorité de santé issued recommendations to develop this practice, which represents a significant source of savings for health insurance. And many advantages for those who are operated on.
Gallbladder removal
At the Jean Verdier hospital in Bondy (93), 70% of cholecystectomies (removal of the gallbladder under laparoscopy, in the event of stones) are performed on an outpatient basis, compared to 10% nationally. Instead of staying one or two nights in the hospital, the patient is operated on in the morning and leaves in the evening. “Thanks to laparoscopy, to the control of vessels and bile ducts, we have succeeded in considerably reducing the postoperative risks”, explains Prof. Corinne Vons, digestive surgeon at the Jean-Verdier hospital in Bondy.
The methods of administration of the products used for general anesthesia have also evolved considerably, the premedication which “shoots” the patient for 12 hours is therefore no longer systematic. The operation lasts one to two hours and the patient is fully awake two hours later. Pain relievers are also infiltrated into the openings of the skin where the trocars (tubes) pass, which slowly dissipate in two days. And we give oral pain relievers and nausea medications to take at home. “If all goes well, I will see the patient again after a month,” explains Professor Corinne Vons.
The fitting of a hip prosthesis
Eight days is the usual length of hospitalization for a total hip replacement. The Capio group recently carried out this intervention during the day. It is offered primarily to people under 75, who are fairly active. At least four preparatory appointments are planned, with the surgeon, the anesthesiologist, the cardiologist, the physiotherapist … The operation lasts less than an hour, under loco-regional anesthesia (lower body) which fades away in two hours.
“The physiotherapist comes in the afternoon to help sit and walk, a quick mobilization that helps to recover better. And we set off again the same evening on our own two feet, with precise instructions and a prescription for painkillers just in case, ”explains Romain Domps, director of the Domont clinic (95). The surgeon calls you the next day and sees you three days, then five weeks later. A nurse comes every day for three weeks for an anticoagulant injection, and changes the bandages (which allow you to shower) every 4-5 days. At the forefront of day surgery, clinics in this group operate over 80% of cruciate ligaments in one day (the national average is 3%). Next step: fitting a knee prosthesis, a more complicated operation.
Breast surgery “in a day”
Gustave Roussy (IGR), the Villejuif institute dedicated to cancer, is one of the pioneers of “one day” breast surgery. For’removal of a tumor, the removal of a sentinel node, a change of breast prosthesis, as well as aesthetic improvement procedures such as lipofilling or reconstruction of the nipple, it is offered as soon as possible. This practice requires good prior information and the patient always has a choice.
The day after the operation, she is contacted by a nurse who makes sure that everything is going well. The results to date are positive: the risk of infection is reduced and the women are very satisfied. Currently in France, 25 to 30% of breast operations are performed on an outpatient basis. This rate is expected to increase rapidly, as more complex procedures, such as breast removal or breast breast reduction for functional and aesthetic reasons, will soon be able to unfold like this.
Treatment of prostate cancer
A patient treated with brachytherapy (a procedure lasting less than two hours consisting of introducing radioactive capsules into the prostate using needles) is generally hospitalized for two nights. The Hospices Civils de Lyon offer support during the day. “The patient performs the preparation (enemas) at home. The urinary catheter is removed immediately after leaving the operating room and if he urinates easily, he is let out. Recovery is thus faster ”, underlines Prof. Olivier Chapet, radiotherapist at the Hospices Civils de Lyon.
And in all cases, less risk of complications
“For the teams, this requires flawless organization. For patients, there are only advantages ”, estimates Professor Corinne Vons, digestive surgeon at the Jean-Verdier hospital in Bondy (93), president of the French Association for Ambulatory Surgery (AFCA). The risk of phlebitis linked to lying down and the risk ofnosocomial infection are reduced. Less invasive techniques and combinations of anesthetics are used that cause fewer side effects. Waking up and recovery is faster.
Anyone can be affected, including children from the age of three. As long as you are accompanied by a loved one and not stay alone the first night, live less than 100 km from the hospital, be sufficiently independent … And above all, be well prepared! Several consultations are scheduled before the operation with the surgeon and the anesthetist to know exactly what to do before (analyzes, possible fasting, treatments). Normal postoperative procedures, instructions and warning signs are explained.
On the day of the operation, you only go home in the evening if the pain and the risk of bleeding are controlled, if you can walk and if you do not suffer from nausea. In practice, less than 5% of those operated on remain hospitalized. The next day, we are called back to check that all is well. In case of concern, the on-call resident or the anesthesiologist can be contacted 24 hours a day. Patients feel more involved and nearly nine out of ten say they are very satisfied. In the future, most operations will be performed on an outpatient basis. Only heavy interventions or those lasting more than three hours, such as coronary bypass surgery, will be excluded.
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