- During recent years duration of hospital stay has been reduced
- Associated with an expansion in day case surgery
- Currently approximately 50% of elective operations are performed as day cases
- Potential benefits include:
- Reduced disruption to patients normal lives
- Psychological benefit of avoiding prolonged hospital stay
- Reduced morbidity including nosocomial infections
- Reduced in-patient waiting lists
- Increased availability of in-patient beds
- Reduced costs
- Safe day case surgery requires appropriate
- Patient selection
- Operative procedures
- Anaesthetic techniques
Patient selection
- Patients should fulfill the following criteria
- Age less than 70 years
- ASA Grade 1 or 2
- BMI less than 30
- Availability of a responsible adult
- Access to a telephone
- Live within an hours traveling time from the hospital
- Requires close co-operation between surgeon, anaesthetist and day unit
- Preoperative screening should be performed
- Can be carried by a questionnaire and/or a nurse-lead assessment clinic
- Patients requiring extensive investigation are not suitable for day case surgery
Operation selection
- Operations for day case surgery vary between specialties
- Appropriateness may be expanded by the facility for an overnight stay
- Generally operations should be:
- Short duration
- Low incidence of postoperative complications
- Not require blood transfusion
- Not require major postoperative analgesia
- Laparoscopic surgery can now be performed, usually with an overnight stay
- Surgery should be performed by an experienced surgeon
- Access to in-patient beds should be available if required
Day case anaesthesia
- Principles of anaesthesia are the same as for in-patient care
- Requires high quality induction, maintenance and recovery
- Recovery should be free from side effects
- Anaesthesia should be performed by an experienced anaesthetist
- Local anaesthetic techniques should be encouraged
Discharge criteria
- Prior to discharge from the day case unit patients should
- Have stable vital signs
- Be alert and orientated
- Be comfortable / pain free
- Be able to walk
- Be able to tolerate oral fluids
- Have minimal nausea and vomiting
- Adequate follow-up arrangements should be made
- Patients should be provided with information sheets
- Should be provided with contact telephone numbers
Bibliography
Crews J C. Multimodal pain management strategies for office-based and ambulatory procedures. JAMA
2002; 288: 629-632.
Rawal N. Analgesia for day case surgery. Br J Anaesth 2001; 87: 73-87.
Schecter W P, Bongard F S, Gainor B J et al. Pain control in outpatient surgery. J
Am Coll Surg 2002; 195: 95-104. |