Outpatient surgery, a

Outpatient surgery, a french curve

The France is a country of contradictions

For twenty years, many french surgeons wanted to do further surgery on an outpatient basis (without patients may need to stay overnight in the hospital), but health authorities were four irons.

The times have changed.

Now, surgeons must sometimes be justified when they keep patients in the hospital! The Ministry of health and social security grow lights. To the extent that it is the national goal to reach 66.2% of operations on an outpatient basis in 2020 seems too optimistic. He is not sure he is reached, because the current rate is 53% (in 2016, with the new perimeter of calculation, 48. .5% with the former). The new perimeter adds “previously considered interventions as part of the Interventional or obstetrical field”, says Dr. . Gilles Bontemps, Member of the National Academy of surgery. “The Minister of health, Agnès Buzyn, guest out ambulatory surgery as the”hospital”,” Pr Jean-Pierre Triboulet, one of the pioneers of ambulatory surgery in France the startup has been slow. In the early 1990s, the United States already had 1 700 independent ambulatory surgery centers, and more than 10 million patients were made each year. In France, one equivocating. Being realized that some, including private institutions, counting “two patients per day in the same bed”, thanks to the ambulatory, social security was producing even a circular “establishing the non-payment of the price of day and costs of. . operating room for acts causing a stay of less than 24 hours’, recalls Dr. . Hubert Johanet, surgeon and Associate Professor (Paris) in the report of the Congress of the French Association of surgery (AFC), which is held in Paris. In 2004, a report of the social security reflected the faith of the converted: “the structure that has not developed the ambulatory whereas it has potential is an anomaly which involves medium-term surgical survival. ” Financial incentives have followed. And the progress is now regular. “It will take close near 100 000 beds on existing 414 000 to align with international standards,” Dr. . Johanet “Agnès Buzyn, the Minister of health, ask out the”hospital”, also ambulatory surgery”, welcomed Wednesday Pr Jean-Pierre Triboulet, one of the pioneers of ambulatory surgery in France. Without concealing that this implies new requirements for teams and healthcare facilities. But the transformation of the system of health french, yet to come, is huge.

“It will take close near 100 000 beds on existing 414 000 to align with international standards, explains Dr. . Johanet. This will require changes to the hospital and the development of new connections between the city and the hospital, the creation of new jobs. ” In the meantime, outpatient surgery units are rarely self-sufficient, while “all countries began their shift to ambulatory care from independent centers,” Note Dr. . Guy Bazin, in the report of the Congress of the AFC. Long the laughingstock of other countries, the France grew quickly when all the players began rowing in the same direction. “We went for example from 6% of inguinal hernias operated outpatient ago 15 years to 68% with some surgical techniques”, explains Dr. . Johanet.

As one of the factors that allowed this progress is undoubtedly the medical technology and, in particular, the advent of laparoscopy, and the establishment of protocols for fast recovery after surgery. ” Another progress determining, adds the surgeon, for anesthesia because we now has products that are eliminated quickly, while previously it took several hours after the operation to wake up. .” Of course, ambulatory surgery will not apply to all patients or all types of operation. “There will always be eligibility criteria,” stresses Dr. . Marc banks (Department of anesthesia of the Institute mutualist Montsouris, Paris). In addition, he believes, “the list of possible actions on an outpatient basis must be made surgeon by surgeon and institution by institution”. Pragmatic tailor-made, – that’s the motto of the Government Philippe? .

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