title: Similar levels of pain are reported in forefoot surgery after management as a day case and admission for 48 hours: A continuous prospective study of 317 patients.
abstract: While many forefoot procedures may be performed as a day case, there are no specific guidelines as to which procedures are suitable. This study assessed the early post-operative pain after forefoot surgery performed a day case, compared with conventional inpatient management. A total of 317 consecutive operations performed by a single surgeon were included in the study. Those eligible according to the criteria of the French Society of Anaesthesia (SFAR) were managed as day cases (127; 40%), while the remainder were managed as inpatients. The groups were comparable in terms of gender, body mass index and smoking status, although the mean age of the inpatients was higher (p < 0.001) and they had higher mean American Society of Anaesthesiologists scores (p = 0.002). The most severe daily pain was on the first post-operative day, but the levels of pain were similar in the two groups; (4.2/10, SD 2.5 for day cases, 4.4/10, SD 2.4 for inpatients; p = 0.53). Overall, 28 (9%) of patients who had their surgery as a day case and 34 (11%) of inpatients reported extreme pain (≥ 8/10). There were more day case patients rather than inpatients that declared their pain disappeared seven days after the surgery (p = 0.02). One day-case patient with excessive bleeding was admitted post-operatively. Apart from the most complicated cases, forefoot surgery can safely be performed as a day case without an increased risk of pain, or complications compared with management as an inpatient.
authors.affiliation: Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique Traumatologique et de Médecine du Sport, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite Cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Chaudier
authors.affiliation: Faculté de Médecine Charles Mérieux, BP12 69921 Oullins Cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Bourdin
authors.affiliation: Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service d'Anesthésie et Réanimation, F-69495, France, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite Cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Gauthier
authors.affiliation: Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite Cedex, France.
authors.forename: M H
authors.initials: MH
authors.lastname: Fessy
authors.affiliation: Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite Cedex, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Besse
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005545:Forefoot, Human / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D013997:Time Factors
keywords: forefoot; day surgery; pain; prospective