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cause of ambulatory failure (52%) was
symptoms related to anesthesia (e.g. nausea
and dizziness). Five patients (22%) were unable
to be discharged due to excessive pain, and five
patients (22%) because of bleeding or longer
surgery. Finally, one patient (4%) had to stay in
hospital because of administrative problem.
Multifactorial analysis of ambulatory failure
showed differences according to sex, duration
of tourniquet, NSAID delivery and side effects
of opioids but no difference was found
whatever the anesthaesia technique used. We
noticed that there was no influence of surgical
technique (type of autograft, treatment of
chondral or meniscal lesions) on daycase
failure, except the presence of drain. The
multifactorial analysis of ambulatory failure
permitted to draw up a kind of composite
image of the outpatient who could be unable to
be discharged: a woman (relative risk (RR)=
3.6) who underwent a surgery with tourniquet
used longer than 50 minutes (RR= 3/ RR= 9,8
if tourniquet duration > 80 minutes), with an
intraarticular drain (RR= 3,3), who didn’t have
NSAID delivered (RR= 4,2) and who took
morphin at D0 (RR= 5,5) with opioid side
effects (RR= 3,6).
Side effects and complications
In the global serie including OG and HG, 70%
patients didn’t have any side effects in D0
evening. The most important side effects were
symptoms related to anesthesia or opioids side
effects: dizziness and discomfort (12%),
digestive disorders (9%), anxiety (3%) and
other side effects (4%).
The rate of adverse effects in D0 evening
decreases significantly with the use of local
anaethetics (locoregional blocks or injection in
hamstring donor-site), except with intra
articular injections.
The administration of dexamethason and
NSAID decreases the rate of side effects at D0,
but both increase abdominal pain in the evening
and in the night after the procedure.
No difference was found between the two
groups (OG and HG) regarding early
complications, except dizziness and anxiety
which were more frequent in the OG.
There were no significant differences found
between the rate of secondary surgery because
of complications in both outpatient (1%) and
hospitalized groups (0,5%).
Regarding complications of anesthesia, there
were no differences between the OG and the
HG.
We found specific complications secondary to
spinal anesthesia: one sciatic pain, two post-
lumbar puncture headaches, two urinary
retentions.
Continuous femoral nerve blocks with catheters
are responsible for more complications
(1 infection on catheter, 12 painful patients
because of problem of battery or obstructed
catheter, 3 falls secondary to weakness of
quadriceps).
CONCLUSION
This study is not a study of feasibility of
outpatient surgery in ACL reconstruction,
which was already done in the USA twenty
years ago and more recently in a French
prospective study [5].
If most of our outpatients were satisfied [8], the
analysis of our failures showed the importance
of a specialised patient pathway to avoid
pitfalls in day case surgery [13].
The management of outpatients needs clear
preoperative information and the postoperative
period has to be anticipated with standard
operating procedures (SOPs) [13].
If the surgeon and the anesthetist don’t have to
change their surgical [7] and anesthetic
techniques [9, 10], they must work together
especially to detect preoperative risk factors of
day case failure [1, 2]. The management of pain