Day Case Surgery

Introduction

Day case surgery is the admission of select patients to hospital for a planned surgical procedure, returning home on the same day. In the UK, this represents about 70% of all surgery performed.

Surgical day cases are often viewed as the highest impact change in healthcare to improve productivity; healthcare guidelines have previously advised for a target of “treating day surgery [rather than inpatient surgery] as the norm for elective surgery”.

The advantages of day case surgery are:

• Shorter inpatient stays
• Reduced risk of hospital acquired infection
• Reduced waiting lists
• Reduced hospital costs
• Reduced demand for inpatient beds

In this article, we shall look at patient selection for day case surgery, the types of procedures that are suitable, and how to prepare a patient as a surgical day case.

Preparing for Day Case

A patient undergoing a day case procedure should be advised not to eat and drink for the 6 hours prior to the surgery (when involving a general anaesthetic). Most departments will allow a patient to drink clear fluids up to 2 hours before the procedure; local guidelines should be adhered to.

Medications should be reviewed to ensure that they will not impact the planned surgery and additional guidance may be necessary from the operating surgeon and / or anaesthetist. Often, this is one of the areas reviewed as part of a pre-operative appointment with a specialist nurse or anaesthetist.

Types of Day Case Surgery

For a surgical procedure to be considered for day case surgery, it must meet the following criteria:

• Minimal blood loss expected
• Low risk of significant immediate complications
• No requirement for specialist aftercare
• Patient can manage pain and enteral nutrition at home
• Able to mobilise

Examples of day case surgery includes inguinal hernia repair, cataract surgery, cystoscopy, arthroscopy, and insertion of grommets

Selection of the Patient

Much of the success of day-case surgery is down to care in patient selection. Most hospitals follow local guidelines to aid in this, which generally include absolute and relative contraindications based on co-morbidities.

The selection of a patient for day surgery should be based upon social and medical factors:

• Social factors – a patient must understand the planned procedure, consent appropriately, and understand the following post-operative care
  • The patient should also have sufficient provisions to have a responsible adult escort them home and provide support for the first 24 hours of post-operative care
• Medical factors – a patient’s health must be suitable for a day case procedure, remembering that some stable chronic diseases (e.g. diabetes mellitus) can often be better managed as a day procedure to minimise any disruption to their daily routine
  • Those with poorly-controlled or severe co-morbidities may not be suitable for a day case pathway