Conclusion
Ambulatory surgery, as currently practiced, has an excellent safety record. Major morbidity is infrequent, and death is extremely rare during or following ambulatory surgical procedures. Less serious, non lifethreatening perioperative adverse events, such as intraoperative cardiovascular events and, most frequently, postoperative excessive pain and PONV, occur with higher incidence. These minor adverse events could result in prolonged postoperative stay, unanticipated hospital admission, or hospital readmission, and they also affect patient satisfaction and postoperative functional level. The occurrence of these minor adverse events is now the major area of quality assessment and an area where improvement could be targeted. The goal of reducing the incidence of minor adverse events related to ambulatory surgery could be achieved by development of less invasive surgical techniques, the use of newer shorter acting anesthetic drugs with fewer side effects, and improved postoperative pain management.
Conclusion
La chirurgie ambulatoire, tel qu’on la pratique, présente une fiche excellente concernant la sécurité. La morbidité grave est rare et la mortalité très rare pendant ou après les interventions chirurgicales ambulatoires. Les complications moins importantes, sans danger pour le patient, comme les troubles cardio-vasculaires peropératoires et, plus souvent, les douleurs intenses postopératoires et les NVPO, ont une plus grande occurrence. Ces incidents mineurs peuvent entraîner un séjour postopératoire prolongé, une admission non prévue à l’hôpital ou une réadmission, et ils peuvent aussi affecter la satisfaction du patient et son niveau fonctionnel postopératoire. L’occurrence de ces complications mineures est maintenant l’enjeu le plus important de l’évaluation de la qualité et de la recherche de solutions visant à l’améliorer. L’objectif de réduire l’incidence des complications mineures de la chirurgie ambulatoire peut être atteint en mettant au point des techniques chirurgicales moins effractives, en utilisant de nouveaux agents anesthésiques d’action rapide aux effets secondaires minimaux et en améliorant le traitement des douleurs postopératoires.
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Chung, F., Mezei, G. Adverse outcomes in ambulatory anesthesia. Can J Anesth 46 (Suppl 5), R18–R34 (1999). https://doi.org/10.1007/BF03013179
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DOI: https://doi.org/10.1007/BF03013179