title: Developments in ambulatory surgery in orthopedics in France in 2016.
abstract: Under the new categorization introduced by the Health Authorities, ambulatory surgery (AS) in France now accounts for 50% of procedures, taking all surgical specialties together. The replacement of full hospital admission by AS is now well established and recognized. Health-care centers have learned, in coordination with the medico-surgical and paramedical teams, how to set up AS units and the corresponding clinical pathways. There is no single model handed down from above. The authorities have encouraged these developments, partly by regulations but also by means of financial incentives. Patient eligibility and psychosocial criteria are crucial determining factors for the success of the AS strategy. The surgeons involved are strongly committed. Feedback from many orthopedic subspecialties (shoulder, foot, knee, spine, hand, large joints, emergency and pediatric surgery) testify to the rise of AS, which now accounts for 41% of all orthopedic procedures. Questions remain, however, concerning the role of the GP in the continuity of care, the role of innovation and teaching, the creation of new jobs, and the attractiveness of AS for surgeons. More than ever, it is the patient who is "ambulatory", within an organized structure in which surgical technique and pain management are well controlled. Not all patients can be eligible, but the AS concept is becoming standard, and overnight stay will become a matter for medical and surgical prescription.
authors.affiliation: Département de chirurgie orthopédique et traumatologique, niveau 11, Inserm U1075 COMETE « mobilité : attention, orientation & chronobiologie », université de Caen Basse-Normandie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France. Electronic address: hulet-c@chu-caen.fr.
authors.forename: C
authors.initials: C
authors.lastname: Hulet
authors.affiliation: Département de chirurgie orthopédique et traumatologique, niveau 11, Inserm U1075 COMETE « mobilité : attention, orientation & chronobiologie », université de Caen Basse-Normandie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Rochcongar
authors.affiliation: Orthopédie TRaumatologie, hôpital Kremlin-Bicêtre, hôpitaux universitaires Paris Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: C
authors.initials: C
authors.lastname: Court
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D005602:France; D006801:Humans; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D009985:Orthopedics / Q000458:organization & administration*; D014193:Trauma Centers / Q000458:organization & administration*
keywords: Ambulatory surgery; Anesthesia; Organization; Patient eligibility; Surgical act