Day case surgery is the admission of selected patients to hospital for a planned surgical procedure, returning home on the same day. They represent about 70% of all surgery in the UK.
Surgical day cases have been identified as the number one high-impact change to improve productivity; in the UK, healthcare guidelines advise 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
- Lower infection rates
- Reduced waiting lists
- Reduced costs
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 small volumes of water up to 2 hours before a general anaesthetic and local guidelines should be adhered to.
Medications should be reviewed to ensure that they will not interfere with the planned surgery and guidance is sometimes necessary from the operating surgeon.
In general, most medications may be continued up to the day of the operation, including the day of the procedure. However, special care should be taken over certain classes of medication, such as anti-coagulants (+/- anti-platelets) in operations where bleeding is a risk.
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
- Short operating time (<1 hour)
- No expected intra-operative or post-operative complications
- No requirement for specialist aftercare
|Procedure||Current Day Case Rate (%)|
|Termination of pregnancy||89.0|
|Submucous septal resection||22.9|
|Extraction of wisdom tooth||87.9|
Table 1 – Examples of surgical procedures performed as a day case in the UK
Selection of the Patient
Much of the success of day-case surgery is down to care in patient selection. In the UK, most hospitals follow local guidelines to aid in this – these 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 or asthma) can often be better managed as a day procedure to minimise any disruption to their daily routine
- Day case surgery has a number of benefits for both patients and healthcare services
- Ensure to adequately discuss and prepare the patients for what to expect from day case surgery
- Both social factors and medical factors can guide suitability to day case surgery