Fast-track recovery after day case surgery

• Published in: Pediatric anesthesia 2015-10, Vol.25 (10), p.1007-1012
• Main Authors: Rhondali, Ossam, Villeneuve, Edith, Queyrel, Géraldine, Delorme, Mijanou, Vischoff, Daniel, Saindon, Sophie, Girard, Marie-Andrée, Charest, Jean, Mathews, Sylvain
• Format: Article
• Language: English
• Subjects: Ambulatory Surgical Procedures - psychology; Ambulatory Surgical Procedures - statistics & numerical data; Child; Child, Preschool; children; day case surgery; Female; Humans; Length of Stay - statistics & numerical data; Male; Pain, Postoperative - epidemiology; parental satisfaction; Parents - psychology; Patient Satisfaction - statistics & numerical data; postoperative complications; Postoperative Complications - epidemiology; Postoperative Complications - psychology; Postoperative Nausea and Vomiting - epidemiology; Postoperative Period; Prospective Studies; Surveys and Questionnaires
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.12699

Summary Background Fast‐track recovery processes are implemented for pediatric day case surgery. We conducted a prospective study to evaluate postoperative comfort and parental satisfaction of children included in this process to improve quality of care. Methods We included all children scheduled for superficial procedures or dental treatment outside the operating room. A questionnaire was explained to parents before hospital discharge to evaluate the first night at home. Postoperative comfort evaluation included postoperative pain score (FLACC scale), incidence of postoperative nausea and vomiting, and postoperative behavior disorders. Incidence of posthospital behavior disturbance was evaluated measuring postoperative agitation at home, and disinterest with toys and games. Parental satisfaction was evaluated with a four‐point Likert scale (1 = not satisfied at all, 2 = not satisfied, 3 = satisfied, 4 = very satisfied). Results One hundred and forty‐three questionnaires were returned to hospital. Despite reduced length of stay in short‐stay unit after anesthesia (28 ± 34 min), we did not report serious complications, and global parental satisfaction was good about the care process. Pain scores (FLACC >3) were higher in the group scheduled for dental procedures, but were very low for the other superficial surgery. With an odd ratio of 5.8 (95% confidence interval 2–17; P = 0.001), postoperative behavior modification (agitation or disinterest with toys or games) was the strongest variable that can predict parental dissatisfaction. Conclusion Optimal pain management, better parental information about risks of postoperative behavior disturbances, and program integrating parent and child preparation should improve quality of care and global satisfaction in the fast‐track recovery process.