International survey and consensus (ICON) on ambulatory surgery in rhinology

L de Gabory; L J Sowerby; J M DelGaudio; A Al-Hussaini; C Hopkins; E Serrano

doi:10.1016/j.anorl.2017.12.010

International survey and consensus (ICON) on ambulatory surgery in rhinology

Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Feb;135(1S):S49-S53. doi: 10.1016/j.anorl.2017.12.010. Epub 2018 Feb 3.

Authors

L de Gabory¹, L J Sowerby², J M DelGaudio³, A Al-Hussaini⁴, C Hopkins⁵, E Serrano⁶

Affiliations

¹ ENT department, University Hospital of Bordeaux, Pellegrin Hospital, F-X Michelet Center, 33076 Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France. Electronic address: ludovic.de-gabory@chu-bordeaux.fr.
² ENT department, Schulich School of Medecine and dentistry, London, Ontario, Canada.
³ ENT department, Emory University, 30322 Atlanta, GA, United States of America.
⁴ ENT department, University Hospital of Wales, Cardiff, United Kingdom.
⁵ ENT department, Guy's and Saint-Thomas' Hospital, London, United Kingdom.
⁶ ENT department, University Hospital Rangueil-Larrey, Toulouse, France.

PMID: 29398505
DOI: 10.1016/j.anorl.2017.12.010

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.

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

Publication types

Consensus Development Conference

MeSH terms

Ambulatory Surgical Procedures*
Health Care Surveys
Humans
Internationality
Middle Aged
Nose Diseases / surgery*
Prospective Studies