French otorhinolaryngology society guidelines for day-case nasal surgery

• Published in: European annals of otorhinolaryngology, head and neck diseases head and neck diseases, 2015-02, Vol.132 (1), p.35-40
• Main Authors: de Gabory, L, Serrano, E, Lecanu, J.-B, Ebbo, D, Coudert, F, Hanau, M, Escabasse, V
• Format: Article
• Language: English
• Subjects: Ambulatory Surgical Procedures - standards; Day-case surgery; Guidelines; Humans; Nasal Surgical Procedures - standards; Otolaryngology; Rhinology; Sinus surgery
• ISSN: 1879-7296; 1879-730X
• DOI: 10.1016/j.anorl.2014.09.001

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.