Session on Office Surgery
Seance of wednesday 23 october 2024 (La chirurgie au cabinet)
DOI number : 10.26299/115j-ta55/emem.2024.27.04
Abstract
We report here the results of the analysis of office surgery practice at the CHU de Nîmes, particularly the impact of this practice on the clinical pathway for the management of carpal tunnel syndrome. The analysis focused on four main items:
• The safety of the path for the patient;
• The quality of care for the patient compared to other management options, whether in terms of anesthesia or surgery;
• The optimization of human and economic resources compared to traditional outpatient care;
• The optimization of carbon footprint compared to standard care pathways.
The relevance of the analysis we present lies in evaluating this practice. Most of the data collected comes from structures responsible for monitoring care pathways (infectious disease specialists, anesthetists, pharmacists, administrative staff) that do not directly carry out the path. This information is essential to demonstrate the objectivity and sincerity of the data.
Dr. Olivier Marès carried out the care pathways in the service of Pr. Kouyoumdjian.
Regarding the pathway's safety, we report a balanced series of 125 patients between office surgery and outpatient surgery, with no infections associated with this practice. Our anesthesia team, which does not perform this practice, has confirmed the safety of the proposed local anesthesia. In a comparative study of 90 cases, we report superior quality and safety of local anesthesia compared to locoregional anesthesia.
The quality of care is superior to that of the traditional outpatient pathway: in a continuous series of 90 patients, overall satisfaction increased from 8.3 to 9.7 from an outpatient circuit to an office circuit, with no increase in complications.
We also analyzed the optimization of human resources, which are reduced by three compared to traditional circuits. There is also cost optimization. The cost of a procedure in the office is less than one-third of that of an endoscopic intervention in an outpatient circuit.
We also analyzed the carbon cost between an endoscopic procedure under locoregional anesthesia in an outpatient setting, an ultrasound-guided procedure under WALANT in an outpatient setting, and a procedure in-office surgery under WALANT and ultrasound.
Office surgery reduces the carbon footprint by 500% compared to an endoscopic procedure in an outpatient setting and by 300% compared to ultrasound-guided surgery in an outpatient setting.
Office surgery provides a new horizon for the management of hand pathologies. It offers a procedure with safety comparable to previous pathways and PROMs and PREMs superior to those pathways. Furthermore, this pathway optimizes the human and financial resources needed to perform these procedures while drastically reducing the carbon footprint.
• The safety of the path for the patient;
• The quality of care for the patient compared to other management options, whether in terms of anesthesia or surgery;
• The optimization of human and economic resources compared to traditional outpatient care;
• The optimization of carbon footprint compared to standard care pathways.
The relevance of the analysis we present lies in evaluating this practice. Most of the data collected comes from structures responsible for monitoring care pathways (infectious disease specialists, anesthetists, pharmacists, administrative staff) that do not directly carry out the path. This information is essential to demonstrate the objectivity and sincerity of the data.
Dr. Olivier Marès carried out the care pathways in the service of Pr. Kouyoumdjian.
Regarding the pathway's safety, we report a balanced series of 125 patients between office surgery and outpatient surgery, with no infections associated with this practice. Our anesthesia team, which does not perform this practice, has confirmed the safety of the proposed local anesthesia. In a comparative study of 90 cases, we report superior quality and safety of local anesthesia compared to locoregional anesthesia.
The quality of care is superior to that of the traditional outpatient pathway: in a continuous series of 90 patients, overall satisfaction increased from 8.3 to 9.7 from an outpatient circuit to an office circuit, with no increase in complications.
We also analyzed the optimization of human resources, which are reduced by three compared to traditional circuits. There is also cost optimization. The cost of a procedure in the office is less than one-third of that of an endoscopic intervention in an outpatient circuit.
We also analyzed the carbon cost between an endoscopic procedure under locoregional anesthesia in an outpatient setting, an ultrasound-guided procedure under WALANT in an outpatient setting, and a procedure in-office surgery under WALANT and ultrasound.
Office surgery reduces the carbon footprint by 500% compared to an endoscopic procedure in an outpatient setting and by 300% compared to ultrasound-guided surgery in an outpatient setting.
Office surgery provides a new horizon for the management of hand pathologies. It offers a procedure with safety comparable to previous pathways and PROMs and PREMs superior to those pathways. Furthermore, this pathway optimizes the human and financial resources needed to perform these procedures while drastically reducing the carbon footprint.