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T. CUCURULO, E. SERVIEN
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All the self-evaluation criteria were entered by
the patient using the
websurvey.frsoftware
which enabled us to have independent
responses with an online link to the electronic
version of the questionnaires.
RESULTS
Pain
The global analysis of pain score didn’t show
any significant difference between the out
patient group and the hospitalized group from
the evening of the procedure to D5.
The follow-up of the evolution of the pain in
the days after surgery showed there is an
increase of pain scores between D0 an D1 in
both groups only for patients who had no
controlled pain just after the procedure. In fact,
patients who had low pain in the evening after
surgery remained pain free the following days.
Multifactorial analysis of the postoperative
pain in both groups showed differences
according to the age, the preoperative pain
scale and the procedure time, but no difference
was found between the outpatient group and
the inpatient group. We noticed that there was
no influence of surgical technique (type of
autograft, treatment of chondral or meniscal
lesions) on postoperative pain. The multi
factorial analysis of the postoperative pain in
the outpatient group permitted to make up a
kind of composite image of the typical painful
outpatient (pain score >7) who is a young girl
(age between 15 and 18), with a preoperative
pain >3 and who underwent a surgery with
tourniquet used more longer than 50 minutes.
There were no differences in the analysis of
VAS regarding to the three modalities of
anesthesia (general, spinal or four nerve blocks
anesthesia).
The analysis of modalities of analgesia by
local anaesthetic (single or continuous nerve
block, intraarticular or donor site injection)
demonstrated a decrease in pain score and
postoperative opioids requirements for patients
who underwent hamstring donorsite injection.
There were no influence in control pain
regarding intraarticular anesthetic injections.
Our results didn’t show a better control of pain
with single or continuous femoral or saphene
nerve blocks compared to periarticular local
anesthetic infiltrations.
Moreover, systemic nonsteroidal anti
inflammatory drugs (NSAIDs) have proved in
our study to be valuable in the management of
postoperative pain between D0 and D5. The
use of systemic glucocorticoids (i.v. dexa
methasone) during the procedure didn’t
improve VAS pain but decreased side effects
such as nausea and vomiting.
Patient satisfaction
Patient satisfaction assessed on D5 was
comparable in the two groups (93% satisfied
patients in the hospitalized group, 94% satisfied
in the outpatient group).
There were no differences in patient satisfaction
regarding the type of graft.
Insufficent control of pain and lack of
preoperative information were the most
frequent causes of unsatisfaction in the out
patient group (4,8% unsatisfied outpatients).
Whereas 23% of the hospitalized patients
declared they would choose a day case surgery
for a future similar intervention, only 10% in
the outpatient group would request
conventional hospitalization.
Ambulatory failure
We considered as a failure of daycase
ligamentoplasty an outpatient who had to stay
at last one further day of hospitalisation. This
study found 3,4% of day case failure
(23 patients/680), with a great variability
between private centers (2% failure) and Public
Teaching Hospitals (12% failure). The major