European Annals of Otorhinolaryngology, Head and Neck diseases 132 (2015) 247

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Editorial

2015, day-surgery year in France?

“Day surgery” is defined by the French Health Authority as “scheduled surgical procedures conducted under technical conditions necessarily requiring the safety provisions of an operating theater, under anesthesia of whatever kind, followed by postoperative surveillance, enabling discharge home on the day of surgery without elevation of risk”. In France, such surgery entails at least 12 hours’ hospital admission (which is not always the criterion applied in other countries) and excludes surgical procedures performed on an out-patient basis [1]. The proportion of day-surgery management has been increasing for several years and, in 2014, a very encouraging system of budgetary incentives was introduced: the national health insurance system made a strong effort, with a single hospital-stay price for all surgical procedures in patients without comorbidity (level I), regardless of whether admission is on a day-hospital basis or for the classical one or two nights. At the same time, the price for all level-I admissions has been cut, so that institutions that fail to follow this “day-care shift” will lose income. A target rate of 50% day surgery is written into the contracts between the State (General Administration of Care Organization and Ministry of Health) and the Regional Health Agencies for 2016 (note that the rate is about 70% in the UK and northern Europe). In our own specialty, a rate of 20% or 30% can easily be achieved by performing short procedures with simple postoperative course, but then seems to constitute a glass ceiling that can only be broken by deliberate and rigorous organization, as it is long and more complex surgery that is involved.

http://dx.doi.org/10.1016/j.anorl.2015.05.007 1879-7296/© 2015 Elsevier Masson SAS. All rights reserved.

The French Society of ORL already has guidelines for certain procedures, such as tonsillectomy. It is important to harmonize practice in our field and that teams that have already adapted their practice toward day surgery should make their protocols known so as to help the ORL community as a whole to make the transition to day management, which should be undertaken as a matter not of accountancy but of increased safety and comfort for our patients. Disclosure of interest The author declares that she has no conflicts of interest concerning this article. Reference [1] HAS-ANAP. Ensemble pour le développement de la chirurgie ambulatoire. Socle de connaissances; 2012. www.has.sante.fr/portail/jcms/c 1242334/ chirurgie-ambulatoire-socle-deconnaissances

F. Denoyelle Service d’ORL, pédiatrique et de chirurgie cervicofaciale, centre de références des malformations ORL rares, Hôpital Universitaire Necker–Enfants-Malades, AP–HP et Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France E-mail address: [email protected]

2015, day-surgery year in France?

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