title: Fast-track recovery after day case surgery.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatric Anesthesia, Hôpital Sainte Justine, Montréal, QC, Canada.|Department of Pediatric Anesthesia, Hôpital Mère Enfant, Lyon, France.
authors.forename: Ossam
authors.initials: O
authors.lastname: Rhondali
authors.affiliation: Department of Pediatric Anesthesia, Hôpital Sainte Justine, Montréal, QC, Canada.
authors.forename: Edith
authors.initials: E
authors.lastname: Villeneuve
authors.affiliation: Department of Pediatric Anesthesia, Hôpital Mère Enfant, Lyon, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Queyrel
authors.affiliation: Clinical Research Unit. Hôpital Sainte Justine, Montréal, QC, Canada.
authors.forename: Mijanou
authors.initials: M
authors.lastname: Delorme
authors.affiliation: Department of Pediatric Anesthesia, Hôpital Sainte Justine, Montréal, QC, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vischoff
authors.affiliation: Department of Pediatric Anesthesia, Hôpital Sainte Justine, Montréal, QC, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Saindon
authors.affiliation: Department of Pediatric Anesthesia, Hôpital Sainte Justine, Montréal, QC, Canada.
authors.forename: Marie-Andrée
authors.initials: MA
authors.lastname: Girard
authors.affiliation: Department of Pediatric Anesthesia, Hôpital Sainte Justine, Montréal, QC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Charest
authors.affiliation: Department of Pediatric Anesthesia, Hôpital Sainte Justine, Montréal, QC, Canada.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Mathews
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000523:psychology* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010149:Postoperative Pain / Q000453:epidemiology; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000523:psychology*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011184:Postoperative Period; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: children; day case surgery; parental satisfaction; postoperative complications