L de Gabory1, E Serrano2, J-B Lecanu3, D Ebbo4, F Coudert5, M Hanau6, V Escabasse7. 1. Service d'ORL et chirurgie cervico-faciale, hôpital Pellegrin, centre Michelet, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France. Electronic address: ludovic.de-gabory@chu-bordeaux.fr. 2. Service d'ORL et de chirurgie cervico-faciale, CHU de Toulouse, 31059 Toulouse cedex 9, France. 3. Institut Arthur-Vernes, Paris, France. 4. Service d' O.R.L. et de chirurgie cervico-faciale, hôpital Saint-Joseph, Paris, France. 5. Cabinet médical, Rueil-Malmaison, France. 6. Centre médical Alexandre-Dumas, Amiens, France. 7. Service d'ORL et de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil et CHU Henri Mondor, 94010 Créteil cedex, France.
Abstract
OBJECTIVES: The French Otorhinolaryngology Society (SFORL) set up a work group to draw up a consensus document on day-case surgery in four rhinologic procedures: endoscopic middle meatal antrostomy (French National Health Insurance (CCAM) code GBPE001), septoplasty (GAMA007), and reduction of nasal bone fracture using a direct approach (LAEA007) and using a closed technique (LAEP002). MATERIALS AND METHODS: Methodology followed the French Health Authority (HAS) "Methodological Bases for Drawing Up Professional Guidelines by Formalized Consensus" published in January 2006; the method chosen was the short version of the RAND/UCLA Appropriateness Method (without editorial group), as the work group topic was highly specialized, with few experts available. RESULTS: Ahead of any day-case sinonasal surgery, it is recommended that patient eligibility criteria be respected and hemorrhagic risk assessed; preference should be given to short procedures involving little variation in surgery time and minimizing blood-loss, and associated procedures (e.g., septoplasty+turbinectomy) should be avoided. The patient and family should be informed of specific hemorrhagic, orbital and/or neuromeningeal risks, onset of which may preclude discharge home. Uni- or bilateral postoperative nasal packing is not a contraindication to day-case management. CONCLUSION: All four procedures may be performed on a day-case basis. Eligibility criteria should be systematically respected, but hemorrhagic risk, which is very specific to the sinonasal organ, is to be assessed on a case-by-case basis, as it is a major issue in this kind of management for a non-negligible number of patients.
OBJECTIVES: The French Otorhinolaryngology Society (SFORL) set up a work group to draw up a consensus document on day-case surgery in four rhinologic procedures: endoscopic middle meatal antrostomy (French National Health Insurance (CCAM) code GBPE001), septoplasty (GAMA007), and reduction of nasal bone fracture using a direct approach (LAEA007) and using a closed technique (LAEP002). MATERIALS AND METHODS: Methodology followed the French Health Authority (HAS) "Methodological Bases for Drawing Up Professional Guidelines by Formalized Consensus" published in January 2006; the method chosen was the short version of the RAND/UCLA Appropriateness Method (without editorial group), as the work group topic was highly specialized, with few experts available. RESULTS: Ahead of any day-case sinonasal surgery, it is recommended that patient eligibility criteria be respected and hemorrhagic risk assessed; preference should be given to short procedures involving little variation in surgery time and minimizing blood-loss, and associated procedures (e.g., septoplasty+turbinectomy) should be avoided. The patient and family should be informed of specific hemorrhagic, orbital and/or neuromeningeal risks, onset of which may preclude discharge home. Uni- or bilateral postoperative nasal packing is not a contraindication to day-case management. CONCLUSION: All four procedures may be performed on a day-case basis. Eligibility criteria should be systematically respected, but hemorrhagic risk, which is very specific to the sinonasal organ, is to be assessed on a case-by-case basis, as it is a major issue in this kind of management for a non-negligible number of patients.
Authors: N Oker; V Dupuch; P Herman; N Leclerc; P Vironneau; H Dang; J Majer; R Pastourel; Y Pavier; J-P Blancal; N Saroul; T Mom; R Kania; E Vicaut; L Gilain; B Verillaud Journal: Eur Arch Otorhinolaryngol Date: 2016-08-17 Impact factor: 2.503