Surgery In France Research Articles

Readmissions After Bariatric Surgery in France, 2013-2016: a Nationwide Study on Administrative Data.

Readmission rate is considered an indicator of quality of care, which is already used in some countries to impose financial penalties on hospital with readmissions in excess of the national average. Nevertheless, this indicator presents some controversial drawbacks. The objective of this study was the assessment of readmission rate after bariatric surgery. This is a retrospective observational study on a national administrative claims database, the Information Systems Medicalization Program, PMSI, which is a nationwide billing tool collecting information on all hospital discharges in France. All adult patients operated of bariatric surgery from January 1, 2013, through December 31, 2016, were included. The main outcome was unplanned 30-day readmission rate. Secondary outcome was the analysis of reasons for readmission. During the study period, out of 187,000 bariatric interventions, the unplanned readmission rate was 4.7%. A significant difference was found between bariatric procedures (gastric banding 3.1%, sleeve gastrectomy 4.5%, gastric bypass 5.7%, p < 0.001). The most important risk factors are the Charlson comorbidity index, the occurrence of a complication after the initial intervention, and the bariatric technique type itself. The main causes of return to the hospital are abdominal pain, peritonitis, nausea/vomiting, and bleeding. After adjustment for confounders, the rate of rehospitalization varies between 1.0% and 16.0% among all French hospitals. Approximately 5 % of patients undergoing bariatric surgery suffered a readmission within 30days. We identified common causes and identified patients at high risk for such an event. These information could be useful for developing strategies to improve in- and outpatient care in bariatric population.

Cost-effectiveness of an educational healthcare circuit for bariatric surgery in France

ObjectivesAn educational healthcare circuit (EHC) is proposed with the objective of preventing weight recovery of patients after bariatric surgery through education and lifestyle change. The objective of this study was to measure the viability of the EHC (shared medical appointments [SMAs] combined with bariatric surgery) through cost-effectiveness analysis. The EHC presented in this study is innovative because it offers a multidisciplinary approach based on medical, psychological and dietetic expertise to combat obesity. The strategy is to give the patient a diagnosis and then a personalised follow-up. Study designA mathematical model based on a decision tree (1 year) and a Markov model (10 years) to measure the efficiency and cost of an EHC in comparison with the customary care offered in France were built. MethodsThe effects of the EHC were observed for the prevalence of type 2 diabetes and the risk of cardiovascular disease. The chosen financial perspective is from the point of view of the French social security system. ResultsThe EHC records an incremental cost-effective ratio (ICER) of € 48,315.43 per quality-adjusted life year (QALY) over a 1-year horizon and € 28,283.77 per QALY over 10 years (with discount rate of 8%: € 25,362.85 per QALY). ConclusionThe results suggest that an EHC is more expensive yet more effective than usual care. That is, in the short term, the costs are high, but at 10 years, the treatment is cost-effective, representing a feasible alternative for those patients who qualify for bariatric surgery in France.

Perioperative morbi-mortality after pelvic organ prolapse surgery in a large French national database from gynecologist surgeons

ObjectiveTo assess morbidity and mortality following pelvic organ prolapse surgery in France, irrespective of the surgical technique, using a broad national database.Materials and methods: This descriptive multicenter retrospective study was conducted using a database populated via an application run by a professional association. Results286 gynecologists contributed data to the database. Of the 4322 surgeries analyzed, an abdominal approach was used in 975 of cases (22.5%), a vaginal approach in 3277 (75.9%), and a combined approach in 68 (1.6%). After one year, abdominal surgery was associated with higher rates of de novo urinary incontinence, constipation, and intestinal obstruction, whereas vaginal surgery was associated with higher rates of urinary retention, hematoma, de novo chronic pain, and vaginal mesh extrusion. There was no significant difference between the groups in the incidence of severe complications. After one year, vaginal mesh-augmented cystocele repair was associated with higher rates of de novo urinary incontinence, de novo chronic pain, and reoperation than native tissue repair. Mesh repair was also associated with higher rates of severe complications at one year. ConclusionAfter pelvic organ prolapse surgery, the perioperative morbidity and mortality associated with transabdominal and transvaginal approaches are similar. However, transvaginal mesh repair is associated with greater perioperative morbidity than transvaginal native tissue repair.

Virtual reality simulation in orthopedics and trauma surgery in France : Current status and perspectives

The current reduction in working hours and the worldwide attempt to guarantee patient safety have led to significant changes in the training of surgical assistants. Numerous studies meanwhile present arthroscopic virtual reality (VR) simulators as very efficient tools for resident training. Based on ameta-analysis of VR arthroscopy simulators that identified different levels of evidence and validity, the situation in France in 2017/2018 is described in response to the new French law prohibiting access to the operating theater without prior simulator training. A total of 7prospective randomized trials were identified that were conducted between 2008 and 2016 in the field of knee and shoulder simulation training. Of the trials six were designed to assess transfer validity. Only four evaluated the simulation-based transfer of knowledge acquired in training to the operating room using an evaluation scale under real-world conditions with blinded assessors. Although France has not yet participated in transfer validation studies, VR simulator training was tested in afirst national cohort and alarge number of assistants were trained for 6months. Even though evidence that the acquired skills can be validly transferred to the operating theater is still needed, especially for arthroscopy, simulation has already become an indispensable form of further training.

Hand surgery in France.

Hand surgery in France.

Perioperative management of patients undergoing antithrombotic treatment in oral surgery in France: a survey

Introduction: The prevention and treatment of thromboembolic events is generally based on the prescription of antithrombotics. These drugs are associated with an increased hemorrhagic risk. The procedures for the management of patients under antithrombotic treatment are described in the recommendations of the Société Française de Chirurgie Orale (SFCO), published in 2015. The main objective of this study was to describe dentists' knowledge and practices regarding the perioperative management of patients under antithrombotic agents in oral surgery in France. Materials and methods: A national cross-sectional study was conducted between June and September 2018. An electronic questionnaire was created on Google Forms and sent through social networks. Results: In total, 185 responses were collected. Two-thirds of the respondents reported that they were aware of the 2015 recommendations. Ten respondents reported that they did not manage patients treated with antithrombotic drugs. Among the respondents who managed such patients, 25% and 16% ordered hemostasis tests for patients treated with direct anticoagulants and antiplatelet agents, respectively. Discussion: Although 71% of dentists considered themselves properly informed, one-third stated that they were not aware of SFCO's 2015 recommendations. Among those who were aware of these recommendations, 47% correctly ordered hemostasis tests before surgery in patients on antithrombotic medication. Conclusion: This study indicates that there is a lack of knowledge and noncompliance with the recommendations among at least half the sample population regarding perioperative management of patients on antithrombotic therapy.

Outpatient management in plastic and reconstructive head and neck surgery in France

The present review lays out the main principles governing outpatient management in the French health system in 2018, and more specifically in plastic and reconstructive head and neck surgery. The historical regulatory aspects and the changes of the last few years are explained, along with the trends and health authorities’ expectations for the years to come. The main limitations to implementing outpatient procedures are the common to all surgical specialities, plastic and reconstructive head and neck surgery being no exception. Apart from purely technical aspects concerning surgical procedure and anesthesia, there are issues concerning institutional approval, the organization and continuity of health care, and the patient's environment. The French General Inspectorate of Social Affairs (IGAS), in its 2012 report on the assessment and pricing of hospital care and medical acts, stated that outpatient surgery was becoming standard practice and conventional admission a fall-back, with the aim of meeting the requirement to provide more care without more expenditure. Outpatient plastic and reconstructive head and neck surgery may be available for most patients, but still presupposes certain conditions.

Description of typical personality factors and events that lead to anxiety at induction of anesthesia in French children.

Preventive strategies are available to reduce preoperative anxiety in children, the ideal time for implementing such strategies remains poorly determined. The aim of this study was to determine psychological factors and events involved in the development of preoperative anxiety in children. This study consisted of prospective evaluations of anxiety trait and state during the preoperative period. Attendance at a preanesthetic consultation is obligatory for all patients undergoing surgery in France. Anxiety trait and state assessments were quantified in mothers and children before and after the preanesthetic consultation using visual analog and faces numerical scales. Preoperative anxiety in children was assessed immediately before induction of anesthesia using an analog scale. Other data recorded included demographic and medical data and type of hospital stay. Univariate and multivariate logistic regression analyses were used. Overall 111 consecutive patients were included. The following factors emerged leading to anxiety state at induction of anesthesia: maternal anxiety state before the preanesthetic consultation, a feeling of not being reassured by the anesthesiologist, maternal anxiety state after the consultation, and anxiety trait in the child. Logistic regression found this combination of factors (OR=4 [1.4 -12]) and inpatient stay (OR=3 [1.4-7]), predicting anxiety with an accuracy of 69%. The present study identified a combination of psychological factors and events associated with the development of anxiety at induction of anesthesia in children. Parental anxiety impacts upon children and occurs before the preanesthetic consultation. This result may assist clinicians to prescribe personalized preventive strategies against anxiety.

État des lieux de la chirurgie ambulatoire de l’obstruction sous vésicale : l’effet laser ?

Despite its feasibility has been proven, Benign Prostatic Hyperplasia (BPH) day-case surgery remains uncommon. Our objective was to describe the evolution of BPH day-case surgery in France according to the surgical technique employed. We extracted data from the Information System of Medicalization Program (PMSI) including all of the hospital stays in France from 2010 to 2016. Patients belonging to the transurethral prostatectomy homogeneous group of patients (GHM 12C04) and having as a main diagnosis prostatic hyperplasia (N40) or benign prostatic tumor (D291) were included in the analysis. From March 2016, specific codes were introduced to differentiate laser surgery and other types of surgery: JGFE023 (resection without laser), JGFE365 (laser resection) and JGNE171 (laser vaporization). We described the rates of day case surgery and the average length of stay from 2010 to 2016. From March 2016 we could study the influence of laser surgery on day-case and length of stay. Regarding the all dataset analysis we found 328,781 hospital stays (318,549 patients) for BPH surgery, of which 2.7% (9047 hospital stays) were day-case. From 2010 to 2016, the lengths of stay decreased from 5.78 to 4.29 days. In the meantime, the number of day-case procedures increased from 14 patients (0.03%) to 3035 patients (5.63%). Regarding the last 9 months of 2016, we found 38,930 hospital stays including 5.4% (2104) day-cases. In total, 92.7% of day-case procedures had been performed with a laser technique, of which 47.9% (1008) were laser vaporization and 44.8% (944) were laser resection. There were only 7.1% (151.8%) of day-case procedures performed without laser. The exponential development of the day-case procedures seems to be linked with the advent of laser technology. This tendency is expected to increase in the coming years according to the spreading of laser surgery. 3.

Association Between Bariatric Surgery and Rates of Continuation, Discontinuation, or Initiation of Antidiabetes Treatment 6 Years Later

Few large-scale long-term prospective cohort studies have assessed changes in antidiabetes treatment after bariatric surgery. To describe the association between bariatric surgery and rates of continuation, discontinuation, or initiation of antidiabetes treatment 6 years after bariatric surgery compared with a matched control obese group. This nationwide observational population-based cohort study extracted health care reimbursement data from the French national health insurance database from January 1, 2008, to December 31, 2015. All patients undergoing primary bariatric surgery in France between January 1 and December 31, 2009, were matched on age, sex, body mass index category, and antidiabetes treatment with control patients hospitalized for obesity in 2009 with no bariatric surgery between 2005 and 2015. Bariatric surgery, including adjustable gastric banding (AGB), gastric bypass (GBP), and sleeve gastrectomy (SG). Reimbursement for antidiabetes drugs. Mixed-effects logistic regression models estimated factors of discontinuation or initiation of antidiabetes treatment over a period of 6 years. In 2009, a total of 15 650 patients (mean [SD] age, 38.9 [11.2] years; 84.6% female; 1633 receiving antidiabetes treatment) underwent primary bariatric surgery, with 48.5% undergoing AGB, 27.7% undergoing GBP, and 22.0% undergoing SG. Among patients receiving antidiabetes treatment at baseline, the antidiabetes treatment discontinuation rate was higher 6 years after bariatric surgery than in controls (-49.9% vs -9.0%, P < .001). In multivariable analysis, the main predictive factors for discontinuation were the following: GBP (odds ratio [OR], 16.7; 95% CI, 13.0-21.4), SG (OR, 7.30; 95% CI, 5.50-9.50), and AGB (OR, 4.30; 95% CI, 3.30-5.60) compared with no bariatric surgery, as well as insulin use (OR, 0.17; 95% CI, 0.13-0.22), dual therapy without insulin (OR, 0.38; 95% CI, 0.32-0.45) vs monotherapy, lipid-lowering treatment (OR, 0.76; 95% CI, 0.63-0.91), antidepressant treatment (OR, 0.67; 95% CI, 0.55-0.81), and age (OR, 0.96; 95% CI, 0.95-0.97) per year. For patients without antidiabetes treatment at baseline, the 6-year antidiabetes treatment initiation rate was much lower after bariatric surgery than in controls (1.4% vs 12.0%, P < .001). In multivariable analysis, protective factors were GBP (OR, 0.06; 95% CI, 0.04-0.09), SG (OR, 0.08; 95% CI, 0.06-0.11), and AGB (OR, 0.16; 95% CI, 0.14-0.20) vs controls, and risk factors were as follows: body mass index category (OR, 2.04; 95% CI, 1.68-2.47 for ≥50.0 vs 30.0-39.9 and OR, 1.68; 95% CI, 1.49-1.90 for 40.0-49.9 vs 30.0-39.9), antihypertensive treatment (OR, 1.49; 95% CI, 1.33-1.67), low income (OR, 1.43; 95 % CI, 1.26-1.62), and age (OR, 1.04; 95 % CI, 1.03-1.05) per year. Bariatric surgery was associated with a significantly higher 6-year postoperative antidiabetes treatment discontinuation rate compared with baseline and with an obese control group without bariatric surgery.

Plastic surgery in bariatric patients: a nationwide study of 17,000 patients on the national administrative database

BackgroundBariatric patients are often candidates for plastic surgery. However, the rate of postbariatric procedures is not known. ObjectivesThe aim of this study was to analyze the rate of plastic surgery, and factors related to surgery, in bariatric patients. SettingUniversity hospital, France. MethodsThis was a cohort study based on administrative data. All adult patients who received bariatric surgery in France between 2007 and 2013 were included to estimate the rate of plastic surgery and related predictive factors. Data are reported according to the reporting of studies conducted using observational routinely collected data guidelines for observational studies on administrative data. ResultsAmong the 183,514 patients who underwent bariatric surgery in the study period, 23,120 plastic surgeries were performed on 17,695 patients, including abdominoplasty (62%), dermolipectomy of the upper or lower limbs (25%), and reconstruction of the breast (14%). The rates of plastic surgery were 13%, 18%, and 21% at 3, 5, and 7 years post–bariatric surgery, respectively. Multivariate analysis revealed that patients who had a biliopancreatic diversion or a gastric bypass had a hazard ratio of 2.67 and 2.67 for subsequent plastic surgery, respectively, compared with patients who had adjustable gastric banding. Women had a 2-fold probability of surgery compared with men (hazard ratio 2.02). Important variability in the rate of surgery was found among different hospitals; rates ranged from 6.1% to 41.3% at 5 years. ConclusionsThis study showed that 21% of bariatric patients undergo plastic surgery. Large variability exists among hospitals, suggesting that several unmeasured factors may limit access to contouring surgery.

General Practitioners and Bariatric Surgery in France: Are They Ready to Face the Challenge?

The epidemic of obesity has determined an important rise in popularity for bariatric surgery (BS) in France. The role of general practitioners (GPs) in the decision-making process of candidates to BS as well as in their life-long follow-up after surgery is therefore destined to grow up. The aim of this survey was to provide a picture of the actual knowledge of GPs about BS. The link to an e-questionnaire composed of 20 multiple choice questions was sent to all the 101 Departmental Councils of the French Medical Board, accompanied by a letter explaining the objectives of the study. Councils were asked to distribute the e-questionnaire to GPs in their department. A total of 2224 GPs were solicited by e-mail in six departments and 288 surveys were completed, representing a 12.9% response rate. A proportion as high as 97.2% of GPs reported taking care of at least one patient operated on for BS and 88.5% declared having referred at least one patient for BS. Nevertheless, a considerable proportion of GPs declared not to have sufficient knowledge to manage BS patients. Moreover, 86.1% wished to receive more education and 83.7% declared to be available for participating in follow-up. Academic institutions, scientific societies, and all physicians involved in obesity care should actively participate in the correction of the educational gap of GPs in order to obtain an effective help in the complex challenge of facing the obesity epidemic.

The Theory and Practice of Pancreatic Surgery in France.

Measure the caseload of pancreatectomies that influences their short-term outcome, at a national level, and assess the applicability of a centralization policy. There is agreement that pancreatectomies should be centralized. However, previous studies have failed to accurately define a "high-volume" center. French healthcare databases were screened to identify all adult patients who had elective pancreatectomies between 2007 and 2012. The patients' age, comorbidities, indication, and extent of surgery, and also the hospital administrative-type and location were retrieved. The annual-caseload of pancreatectomy was calculated for each hospital facility. The primary endpoint was 90-day mortality. Spline modeling was used to identify the different annual-caseload that influenced mortality. Logistic regressions were performed to assess if their influence was independent of confounders, and the accuracy of the model calculated. Overall, 22,366 patients underwent a pancreatectomy and the mortality was 8.1%. Two cut-offs were identified (25 and 65 per year): compared with centers performing >65 resections per year, the adjusted OR of mortality was 1.865 (1.529-2.276) in centers performing ≤25 resections per year and 1.234 (1.031-1.478) in those performing 26 to 65 resections per year. The average number of facilities performing ≤25, 26 to 65, and >65 pancreatectomies per year was 456, 20, and 9, respectively. The percentage of patients operated in these facilities was 56.6%, 19.9%, and 23.3%, respectively.For pancreaticoduodenectomies (12,670 patients; mortality 9.2%), there were 2 cut-offs (16 and 40 pancreaticoduodenectomies per year), and both were independent predictors of mortality (adjusted OR of 1.979 and 1.333). For distal pancreatectomies (7085 patients; 6.2% mortality), there were 2 cut-offs (13 and 25 distal pancreatectomies per year), but neither was an independent predictor of outcome (area under the receiver-operating characteristic curve of the model = 0.778). Centralization of pancreatic surgery is theoretically justified, but currently unrealizable. As the incidence of pancreatic cancer increases, there is an urgent need to improve the training of surgeons and develop both intermediate and high-volume centers.

Cosmetic Surgery on Trial: How the Dujarier Case Impacted its Practice and Structure in France during the Interwar Period

This article aims to shed light on the impact of trials on the structure of cosmetic surgery in France in the interwar period, and more specifically on the argumentative strategy these surgeons used to justify their therapeutic merits. The significant surge in the number of articles and books devoted to cosmetic surgery published during the court hearings reflects the growing professional and social interest in the 'scandalous' practice. Resorting to the reading grid used by pragmatic sociologists is a way to take the surgeons defending or practising cosmetic surgery to their word. The analysis of the stance adopted by the surgeons will be twofold: they are quite revealing of a way of constraining cosmetic surgery but they also help bring to light what is at stake in the medical arena and what drove doctors to support a denigrated practice.

Operation and organisation of ambulatory surgery in France. Results of a nationwide survey; The OPERA study

Operation and organisation of ambulatory surgical activity in France remains largely undocumented. This nationwide observational prospective survey, carried out between December 2013 and December 2014, was undertaken to characterise the organisational processes of ambulatory surgery in France. Three hundred centres were randomly chosen from a list of 891 hospitals practicing ambulatory surgery, with stratification according to the type of facility (public general hospital, university hospital, private hospital) and region. An email was sent to the board of the randomly chosen facilities with an attached information letter explaining how the survey worked. Hospitals who did not reply to this email were contacted by phone. Among the 206 hospitals that answered the survey, 92 were private, 78 were public and 36 were university hospitals. Median accommodation capacities of ambulatory units were 8 beds, mostly distinct from conventional surgical ward. Patient pathways dedicated to ambulatory surgery appear as the current predominant practice. 77% of the French ambulatory units have a head nurse in charge of logistics and coordination. Several items still have to be improved, such as the adherence to modern fasting rules and the unnecessary use of stretcher to move the patient. Objective discharge score is used in 77% of ambulatory units. This survey highlights the implementation of some positive organisational parameters corresponding to common good practices recommendations. In contrast, several other recommendations are still insufficiently applied and may hamper the development of safe ambulatory surgery. This brings up new challenges for health regulatory boards, hospitals and ambulatory units managers.

Why Would a Patient Complain of Dysphagia and Heartburn After Multiple Bariatric Surgeries?

Question: A 43-year-old woman presented for management of a complication of her bariatric surgery. The history goes back to September 2000 when the patient presented with a body mass index (BMI) of 45 (120 kg to 1.63 m). An adjustable gastric band was placed. One year postoperatively, the band migrated, which resulted in removal of the band. In 2003, the patient regained weight and reached a BMI of 47 kg/m2. She underwent a Roux-en-Y gastric bypass. The Roux-en-Y gastric bypass failed in the long term; the patient regained weight and reached a BMI of 45. A supportive band was also placed on the gastric pouch and failed to result in significant weight loss, which necessitated its removal. Currently, the patient has a BMI of 55 and she complains of heartburn accompanied by intermittent abdominal epigastric pain and dysphagia for solid food for the last few months. A 3-dimensional thoracoabdominal computed tomography (CT) scan was done (Figure A–C). What is the diagnosis and how it should be managed? Look on page 654 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI. A 3-dimensional thoracoabdominal CT scan was done that showed herniation of the gastric pouch, the gastrojejunal anastomosis, the alimentary limb, and the residual excluded stomach into the thoracic cavity through the hiatal orifice (Figure A–C). The patient underwent laparoscopic reduction of the intrathoracic contents into the abdominal cavity and repair of the hiatal orifice. Mesh repair of the hiatal defect was preferred. The postoperative course was uneventful. She was doing well at follow-up 6 months after surgery. Bariatric surgery is booming in all countries.1Debs T. Petrucciani N. Kassir R. et al.Trends of bariatric surgery in France during the last 10 years: analysis of 267,466 procedures from 2005–2014.Surg Obes Relat Dis. 2016; 12: 1602-1609Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar However, hiatal hernia is an uncommon pathology after bariatric surgery. The patient underwent multiple bariatric surgeries, with repeated dissection of the angle of His and the diaphragmatic crura, which might have increased the risk of herniation, owing to enlargement of natural orifices such as the hiatal orifice. The reduced formation of adhesions owing to the laparoscopic approach could also play a role. Morbid obesity itself is an independent risk factor for development of hiatal hernia. The intra-abdominal and visceral fat in obese patient leads to a higher intragastric pressure. In addition, obesity reduces the inferior esophageal sphincter pressure and causes esophageal motility problems. Abnormal changes in the collagen and reduced elastin in the diaphragmatic crura after bariatric surgery predispose these patients to hiatal hernias.2Pandolfino J.E. El-Serag H.B. Zhang Q. et al.Obesity: a challenge to esophagogastric junction integrity.Gastroenterology. 2006; 30: 639-649Abstract Full Text Full Text PDF Scopus (395) Google Scholar, 3Curci J.A. Melman L.M. Thompson R.W. et al.Elastic fiber depletion in the supporting ligaments of the gastroesophageal junction: a structural basis for the development of hiatal hernia.J Am Coll Surg. 2008; 207: 191-196Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar Management of hiatal hernia after bariatric surgery consists of reduction of the contents into the abdominal cavity, closure of the hiatal orifice and mesh repair.

Low-Cost Training Simulator for Open Dismembered Pyeloplasty: Development and Face Validation

Surgical simulation has benefited from a surge in interest over the last decade because of the increasing need for a change in the traditional apprenticeship model of teaching surgery. Open surgery for ureteropelvic junction (UPJ) poses unique training challenges owing to smaller workspaces, and finer sutures used that require increased surgical dexterity when compared with adult analogues. We describe the development and face validation of a low-cost training simulator for open dismembered pyeloplasty. The simulator is built with A4 Kraft envelopes, catheter tip syringe filled with 30mL of air, tape, 260 modeling balloon, and 11-in party balloon. Evaluation of the device is based on an evaluation form including 11 items on a 5-point Likert-type scale. Thirty-one departments of pediatric surgery in France were contacted and received a pack containing 4 to 10 devices, already set up and ready for use, a tutorial and an evaluation form. Candidates were stratified according to their level of expertise. A total of 180 devices were sent. Procedures on the device were performed 118 times (65%) by expert surgeons (n = 44), fellows (n = 25), and residents (n = 49). Statistically significant difference was noted for 4 items (anatomy, model exposition, UPJ resection, and difficulty) for the 3 levels of expertise. The global score evaluation for realistic items, face validity, and usability was 4.2 (range: 1-5). This low-cost model is evaluated as an efficient tool for UPJ teaching and training. It shows promise as an educational tool.

Assessing technical competence in laparoscopic surgery in France: Ratification of the GOALS rating scale

BackgroundThe question of assessing surgical competence is the focus of mainly Anglo-Saxon studies. The GOALS questionnaire (Global Operative Assessment of Laparoscopic Skills) specific to laparoscopic surgery assessment has been developed since 2005. The aim of the study was to assess the metrological qualities of the GOALS questionnaire after ratification in French language. MethodsTo produce a French version of the GOALS surgical competence assessing tool according to an established method (translation – backward translation – retranslation) and to check the metrological qualities (user satisfaction, acceptability, reliability and validity) of this questionnaire through observing residents while in training program on 22 residents in Gynaecology Obstetrics during the laparoscopy training, with the performance of a nephrectomy on a porcine model. ResultsThe discrepancies in the initial translations were mainly due literal translations. Only synonymous differences were observed in the two backward translations. Comparison with original version led to 8 minor changes. No changes occurred between the 2 French versions. Satisfaction surveys when using the GOALS questionnaire by both examiners and students are similar. Face and content validity seemed good and there is no significant discrepancy between the examiners and the students (11.5 [9–15]; 12.4 [9–15]; P=0.40). Assessment by examiners showed an median value of 17.8 [9–26] with good correlation (α=0.80). By contrast, self-assessment, although there is no significant discrepancy, showed heterogeneity. GOALS French version was able to prove a significant progression both in self-assessment and external evaluation between the act performed on the first nephrectomy on the first day of the first session of the training and the fourth nephrectomy performed on the first day of the second session of the training. ConclusionOur work allowed obtaining a GOALS French version with acceptable validity, good consistency between the assessments and ability to measure progress.

What is the care pathway of patients who undergo thyroid surgery in France and its potential pitfalls? A national cohort

ContextThe rate of thyroid cancer is increasing in France, as well as concerns about overdiagnosis and treatment.ObjectivesTo examine the care pathway of patients who undergo thyroid surgery in France and...

Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy

ObjectivePerioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. MethodsThe billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests. ResultsOur analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; P<0.001, delta of € 13,876) and a prolonged length of hospital stay (mean of 10 to 27 days; P<0.001, delta of 17 days). According to estimates for complications avoided by PGDT, there was a projected reduction in average healthcare costs of between € 854 and € 1458 per patient and a reduction in total hospital bed days from 1755 to 4423 over three years. Based on French National data (47,000 high risk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation. ConclusionOur analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures.