Récupération améliorée après chirurgie (RAAC) et chirurgie ambulatoire pour prothèse de hanche

Abstract

Total hip arthroplasty has experienced a real evolution in recent years with the democratization of rapid recovery and outpatient surgery for this procedure. These evolutions have been made possible by the development of minimally invasive surgical techniques and the improvement of anesthetic modalities. The patient's journey has been transformed to allow appropriate care structures to perform these heavy surgeries in short-term hospitalizations. Different rapid recovery management criteria have been identified, starting from the first surgical consultation, to ensure the eligibility of the patient for early discharge. The information of the patient and his accompaniment must be carefully orchestrated so that the patient and his entourage adhere and prepare for this care. During the procedure, the coaction between surgical team and anesthetic is essential. The goal for the surgeon is the use of minimally invasive techniques, drainage limitation and perioperative bleeding management, in conjunction with the anesthetist. The infiltration of local anesthetics during the surgery reduces postoperative analgesics and therefore their side effects, which remains one of the priorities of the anesthesiologist. In the postoperative period, stand up is done with the help of the physiotherapist in the first hours after returning to the room. Analgesic management is essential to allow the patient to get up without pain in order to make him confident. He can thus consider a quick return home. This return must be framed by the call, or the survey of a trained nurse, who ensures the smooth postoperative period, comfort the patient and check the drug intake. Rapid recovery is gradually becoming the “gold standard” with, in recent years, routine completion of total hip replacement in outpatients. This practice provides quality care without increasing the risk of postoperative complications. The benefits are numerous for the patient, who regains his life comfort earlier, and for the health system, which reduces the costs associated with long hospitalization.