Breaking Barriers to Successful Implementation of Day Case Laparoscopic Cholecystectomy.
Reynolds I,Bolger J,Al-Hilli Z,Hill A D K
Irish medical journal
Laparoscopic cholecystectomy is a common procedure performed in both emergency and elective settings. Our aim was to analyse the trends in laparoscopic surgery in Ireland in the public and private healthcare systems. In particular we studied the trend in day case laparoscopic cholecystectomy. National HIPE data for the years 2010-2012 was obtained. Similar datasets were obtained from the three main health insurers. 19,214 laparoscopic cholecystectomies were carried out in Ireland over the 3-year period. More procedures were performed in the public system than the private system from 2010-2012. There was a steady increase in surgeries performed in the public sector, while the private sector remained static. Although the ALOS was significantly higher in the public sector, there was an increase in the rate of day case procedures from 416 (13%) to 762 (21.9%). The day case rates in private hospitals increased only slightly from 29 (5.1%) in 2010 to 40 (5.9%) in 2012. Day case laparoscopic cholecystectomy has been shown to be a safe procedure, however significant barriers remain in place to the implementation of successful day case units nationwide.
Applying a managerial approach to day surgery.
Onetti Alberto
International journal of surgery (London, England)
The present article explores the day surgery topic assuming a managerial perspective. If we assume such a perspective, day surgery can be considered as a business model decision care and not just a surgical procedure alternative to the traditional ones requiring patient hospitalization. In this article we highlight the main steps required to develop a strategic approach [Cotta Ramusino E, Onetti A. Strategia d'Impresa. Milano; Il Sole 24 Ore; Second Edition, 2007] at hospital level (Onetti A, Greulich A. Strategic management in hospitals: the balanced scorecard approach. Milano: Giuffé; 2003) and to make day surgery part of it. It means understanding: - how and when day surgery can improve the health care providers' overall performance both in terms of clinical effectiveness and financial results, and, - how to organize and integrate it with the other hospital activities in order to make it work. Approaching day surgery as a business model decision requires to address in advance a list of potential issues and necessitates of continued audit to verify the results. If it does happen, day surgery can be both safe and cost effective and impact positively on surgical patient satisfaction. We propose a sort of "check-up list" useful to hospital managers and doctors that are evaluating the option of introducing day surgery or are trying to optimize it.
10.1016/j.ijsu.2008.12.031
Clinical practice and routines for day surgery in Sweden: implications for improvement in nursing interventions.
Stomberg M Warrén,Segerdahl M,Rawal N,Jakobsson J,Brattwall M
Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
The purpose of this study was to examine nursing practice in day surgery settings in Sweden. A questionnaire focusing on the routines of the day surgery process of patients in Sweden was administered. Based on these findings, appropriate nursing interventions are outlined and discussed. Day surgery routines were in accordance with general worldwide practice. The study revealed that nursing involvement was rare in the preoperative routine. In addition, the major part of the recovery process, including assessments of discharge eligibility and information about pain management, was managed by PACU nurses. The nurse follow-up revealed a number of subjective queries and symptoms that, in a seemingly easy way, could have been prevented by further perianesthesia/perioperative patient education. There is an obvious place for nursing interventions when the decision for day surgery is taken. These interventions should focus on providing the patient with information before surgery, preoperative patient health screening, and information/education at discharge. Furthermore, nursing interventions should include quality assurance, such as follow-up calls for the evaluation of care, as well as providing information and coaching for the patient at home.
10.1016/j.jopan.2008.07.003
[Setting up a day surgery department].
Buard Frédérique
Soins; la revue de reference infirmiere
Day surgery must be treated as a priority. The efficient implementation of an outpatient structure therefore requires strict rigour in terms of patient eligibility, organisation of the flows as well as the safety of the care pathway and the logistics.
[The organizational challenges of day surgery for hospitals].
Ionescu-Balhawan Cristina
Soins; la revue de reference infirmiere
The ambulatory and conventional care models should not be opposed to one another as they can in fact feed off and enrich each other. The outpatient culture inspires and encourages the drive for more innovative forms of organisation. As a result, a "patient" model emerges, centred on a holistic approach to organisation and patient care.
[The economic challenges of day surgery].
Bizard Frédéric
Soins; la revue de reference infirmiere
The development of day surgery requires the hospital system to be restructured in order for real savings to be made. The hospital must therefore modify its organisational set-up to reap the benefits of the efficiency gains resulting from the development of day surgery.
Evaluation of day care versus inpatient cataract surgery performed at a Jiangsu public Tertiary A hospital.
Zhuang Min,Cao Juan,Cui Minglan,Yuan Songtao,Liu Qinghuai,Fan Wen
BMC ophthalmology
BACKGROUND:High cataract incidence and low cataract surgical rate are serious public health problems in China, despite the fact that efficient day care cataract surgery has been implemented in some public Tertiary A hospitals in China. In this study, we compared not only clinical outcomes, hospitalization time and total costs but also payment manners between day care and inpatient procedures for cataract surgery in a Jiangsu public Tertiary A hospital to put forward several instructional suggestions for the improvement of government medical policies. METHODS:In total, 4151 day care cases and 2509 inpatient cases underwent the same cataract surgery in the day care ward and ordinary ward respectively, and were defined as two groups. General information, complications, postoperative best corrected visual acuity (BCVA), hospitalization time, total costs and especially payment method were analyzed to compare day care versus inpatient. RESULTS:The general data display no significant differences (P > 0.05), and no significant difference between complications and postoperative BCVA were observed between the two groups (P > 0.05). The period of stay in hospital was significantly different (P < 0.001). The total costs were lower for day care than for inpatients (P < 0.001). To avoid sampling error, we analyzed the data of payment manner for each patient among this period. Day care patients tended to pay for the procedure using the Urban Employees Basic Medical Insurance (UEBMI) method, while inpatients tended to use the Out-of-Pocket Medical Treatment (OMT) payment method (P < 0.001). CONCLUSION:Day surgery of cataract is more cost-effective and efficient than inpatient surgery with equivalent clinical outcomes. As an efficient therapeutic regimen, day care surgery should be further promoted and supported by the government policies.
10.1186/s12886-018-0800-8
Reasons for delayed patient discharge following day surgery: a literature review.
Rae Alison
Nursing standard (Royal College of Nursing (Great Britain) : 1987)
Aim The aim of this literature review was to explore the reasons why some patients are not suitable for discharge following day surgery. Method A pragmatic, mixed-methods approach was used to undertake a critical evaluation of the literature and current practice to determine what is already known about discharge following day surgery. Thematic analysis was used to identify the main themes and issues, enabling recommendations to be made to reduce the incidence of patients unable to be discharged following day surgery. Findings The main themes or reasons for delayed discharge following day surgery identified from the literature review were: post-operative nausea and vomiting, post-operative pain, going late to theatre and social factors. These themes were supported by the findings of an unpublished audit carried out in one day surgery unit in an NHS healthcare organisation in the south of England between June and August 2014, which indicated that 54 out of 1,180 day surgery patients required an overnight stay during this 12-week period. The audit also showed that a patient going late to theatre had the greatest effect on discharge outcomes. Conclusion Recommendations for practice include: the introduction of post-operative nausea and vomiting risk scoring and prophylactic protocols; reorganisation of theatre lists to ensure patients have enough time to recover; and provision of information during the pre-assessment process about the requirement for a responsible adult escort to take patients home and stay with them for the first 24 hours. These changes may help NHS organisations to improve discharge outcomes for day surgery patients and reduce unplanned costs.
10.7748/ns.2016.e10292
High risk patients in day surgery.
Bettelli G
Minerva anestesiologica
Day surgery (DS) is continuously expanding due to both economic pressure and improvement in surgery and anesthesia. In the 1970s, only healthy patients undergoing simple procedures were accepted. Subsequent studies demonstrated that mortality and major morbidity are rare. Complicated patients are now considered suitable for DS in the current clinical practice. The aim of this article is to discuss the concept of risk evaluation in DS and to examine potentially risky situations. The outcomes that should be considered are intermediate and late outcomes, such as unplanned admission or return to hospital. Risk factors are the patient's clinical status, surgery and anesthesia and the kind of facility. Little evidence exists on what conditions should be considered predictors of adverse outcomes after DS. Non-compensated, poorly-stabilized cardiac and respiratory patients, obstructive sleep apnea, age >85 years and preterm infants are at high risk of complications. Unplanned admission or return to the hospital are more frequent after ENT and urology DS. Whether or not outpatient tonsillectomy is safe is controversial. The reported death rate per 100,000 procedures is 9.2 in offices and 0.78 in DS centers. Complicated patients need careful, time-appropriate and team-based preoperative evaluation by expert anesthetists with appropriate knowledge of DS. Patient clinical status is only one of the factors that should be considered. Surgeon's and anesthetist's skill, surgery and anesthesia technique and surgical setting are equally important. Therefore, only after evaluating their own experience and results are DS centers allowed to decide whether or not to treat a challenging patient as an outpatient.
Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice.
Owojuyigbe Afolabi Muyiwa,Komolafe Edward O,Adenekan Anthony T,Dada Muyiwa A,Onyia Chiazor U,Ogunbameru Ibironke O,Owagbemi Oluwafemi F,Talabi Ademola O,Faponle Fola A
African journal of paediatric surgery : AJPS
BACKGROUND:It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. OBJECTIVE:To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. PATIENTS AND METHODS:A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. RESULTS:A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. CONCLUSION:Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved.
10.4103/0189-6725.182561
Early experience of day care surgery in Nepal.
Singh D R,Joshi M R,Koirala U,Shrestha B R,Shrestha S,Gautam B
JNMA; journal of the Nepal Medical Association
INTRODUCTION:The day care laparoscopic cholecystectomy (DCLC) is found to be safe and effective in developed countries. However, it has not been well accepted in our part of the world probably because of lack of infrastructures,established norms and published reports. We have analyzed the safety and feasibility of the procedure in the recently established first dedicated day care surgery centre of the country. METHODS:All the patients with American society of anaesthesiologist (ASA) score I and II admitted for laparoscopic cholecystectomy are included. Operation are performed in the morning and closely observed till evening. Patients found to be medically fit to discharge; having a responsible person at home and who can make their own arrangements in case of problems were advised for discharge. Follow up was done by telephone call from next morning. RESULTS:Total 35 patients underwent laparoscopic cholecystectomy. Age range was between 16-65 years and most of them were females (88%). Only 30 patients were operated in early morning and were eligible for day care surgery. 25 (83%) Patients were advised for discharge but only 10 (33%) could make arrangement. Other 15 patients could not go home mainly due to different psychosocial reasons. Only one patient needed readmission and Complications observed were minor and relatively few. CONCLUSIONS:Day care laparoscopic cholecystectomy is safe and feasible in our set up. Acceptance of the procedure is expected to increase once it is regularly practiced and awareness in improved.
"Like a trip to McDonalds": a grounded theory study of patient experiences of day surgery.
Mottram Anne
International journal of nursing studies
BACKGROUND:The amount and complexity of (ambulatory) day surgery is rapidly expanding internationally. Nurses have a responsibility to provide quality care for day surgery patients. To do this they must understand all aspects of the patient experience. There is dearth of research into day surgery using a sociological frame of reference. OBJECTIVE:The study investigated patients' experiences of day surgery using a sociological frame of reference. DESIGN:A qualitative study using the grounded theory approach was used. SETTING:The study was based in two day surgery units in two urban public hospitals in the United Kingdom. PARTICIPANTS:145 patients aged 18-70 years and 100 carers were purposely selected from the orthopaedic, ear nose and throat and general surgical lists. They were all English speaking and were of varied socio-economic background. METHODS:The data was collected from 2004 to 2006. Semi-structured interviews were conducted on three occasions: before surgery, 48 h following surgery and one month following discharge. Permission was received from the Local Research Ethics Committee. Analysis of the data involved line-by-line analysis, compilation of key words and phrases (codes) and constant comparison of the codes until categories emerged. FINDINGS:Patients liked day surgery and placed it within the wider societal context of efficiency and speed. Time was a major issue for them. They wished surgery, like all other aspects of their life to be a speedy process. They likened it to a McDonald's experience with its emphasis on speed, predictability and control. CONCLUSION:This study throws new light on patient experiences and offers an understanding of day surgery against a western culture which emphasises the importance of speed and efficiency. It is a popular choice for patients but at times it can be seen to be a mechanistic way of providing care. The implications for nurses to provide education and information to add to the quality of the patient experience are discussed.
10.1016/j.ijnurstu.2010.07.007
Day case surgery and developing countries: a review.
Ojo E O
Nigerian journal of clinical practice
BACKGROUND:Day case surgery (DCS) is increasingly practiced all over the world but with a lag between the developed and developing continents. While it has witnessed a boom in the continents of America and Europe culminating in the establishment of Freestanding and autonomous units, the developing countries still largely practice hospital based day cases with relatively limited scope and utilization. OBJECTIVE:This article reviews the evolution, scope, safety, organisation including the standard necessary for establishing and practicing day case surgery and examines the practice in the developing world. DESIGN:Electronic literature search combined with review of both local journals and relevant texts. OUTCOME:There is increasing need, applicability, potentials and relevance of day case surgery in the developing world with potential huge economic and social benefits. CONCLUSION:As modern day case surgery practice requires dedicated services with meticulous attention equal to that given to in-patients, efforts should be focused on providing efficient services, in well structured centres, ploughing back resources to improve infrastructural/organisational deficiencies and acquiring relevant technology with skills in the developing world.
Contemporary day surgery: patients' experience of discharge and recovery.
Gilmartin Jo
Journal of clinical nursing
AIM:To explore and reveal patients' perceptions of discharge arrangements and recovery following day surgery. INTRODUCTION:Contemporary day surgery is increasingly being used to carry out elective surgical procedures enabling patients to be discharged on the same day. The Department of Health and government modernization programmes in the UK have encouraged this rapid growth. Preparation for discharge is important because patients require knowledge and understanding about self-management and access to primary health care services if required. METHODS:Using a phenomenological approach, data were collected by unstructured interviews from 30 patients undergoing gynaecology, urology and general surgery procedures. RESULTS:Deficits in patient preparation for discharge including the timing of information giving postprocedure for all groups were highlighted. The gynaecology patients pointed to a specific lack of verbal information about resuming sexual activity following procedures. Some general surgery and urology patients alluded to finding it stressful coping with threats to body image through 'skin discoloration', 'swelling' or 'bruising', because they did not know what to do. A number of urology patients talked about the challenges posed by difficulty with voiding, dysuria and haematuria. RELEVANCE TO CLINICAL PRACTICE:The results and problems identified have applicability for the development of discharge planning services and patient education in a day surgery context. It is suggested that the use of evidenced-based and innovative interventions among health professionals might improve patient outcomes.
10.1111/j.1365-2702.2007.01548.x
Day surgery: patients' felt abandoned during the preoperative wait.
Gilmartin Jo,Wright Kerrie
Journal of clinical nursing
BACKGROUND:The rapid expansion in day surgery has facilitated a shift in surgical nursing intervention. The evolving evidence base has a major part to play in influencing nurse-led preassessment, information provision, pain management and postoperative intervention. However, the literature is characterised by a number of deficits: poor attention to patient experience from admission to discharge, anxieties evoked and the potential needs of patients are not well articulated. AIM:The purpose of this paper is to describe and interpret patients' experiences of contemporary day surgery. METHOD:This hermeneutic phenomenological approach focused on the experience of 20 adult patients. Data was collected by using unstructured interviews. The transcripts were interpreted through the identification of four prevalent themes using the phenomenological method. FINDINGS:The themes that emerged from the data are emphasised, ranging from the feeling of empowerment during preparation, through apprehensions encountered and the feeling of abandonment in the preoperative waiting area, to recovery dynamics. CONCLUSION:The study demonstrates that the majority of the patients felt abandoned in the preoperative stage and nurses did not recognise the importance of ongoing psychological support. Therefore, it is crucial to strengthen the provision of emotional support and person-centred care in a day surgery context. There is also a need to be aware that environmental factors can impact on patient anxiety, promoting the use of music preoperatively can reduce anxiety and increase well-being. RELEVANCE FOR CLINICAL PRACTICE:Crucially health professionals need to facilitate person-centred and continuity of care throughout the day surgery experience. Using dynamic interpersonal skills, such as active listening 'holding''containment' and attunement to reduce anxiety and feelings of abandonment in the preoperative period. Moreover, being alert to verbal utterances, para-language and non-verbal cues demonstrated by the patient. Specific information about delays regarding the timing of procedures needs to be carefully explained.
10.1111/j.1365-2702.2008.02374.x
Surgical care in low and middle-income countries: burden and barriers.
Ologunde Rele,Maruthappu Mahiben,Shanmugarajah Kumaran,Shalhoub Joseph
International journal of surgery (London, England)
Surgically correctable pathology accounts for a sizeable proportion of the overall global burden of disease. Over the last decade the role of surgery in the public health agenda has increased in prominence and attempts to quantify surgical capacity suggest that it is a significant public health issue, with a great disparity between high-income, and low- and middle-income countries (LMICs). Although barriers such as accessibility, availability, affordability and acceptability of surgical care hinder improvements in LMICs, evidence suggests that interventions to improve surgical care in these settings can be cost-effective. Currently, efforts to improve surgical care are mainly coordinated by academia and intuitions with strong surgical and global health interests. However, with the involvement of various international organisations, policy makers, healthcare managers and other stakeholders, a collaborative approach can be achieved in order to accelerate progress towards improved and sustainable surgical care. In this article, we discuss the current burden of global surgical disease and explore some of the barriers that may be encountered in improving surgical capacity in LMICs. We go on to consider the role that international organisations can have in improving surgical care globally. We conclude by discussing surgery as a global health priority and possible solutions to improving surgical care globally.
10.1016/j.ijsu.2014.07.009
Day care cataract surgery in Central and Southern Italy: a multicentric survey.
Cillino Salvatore,Casuccio Alessandra,Di Pace Francesco,Pillitteri Francesco,Cillino Giovanni,Lodato Gaetano
BMC health services research
BACKGROUND:Cataract day surgery has rapidly gained worldwide acceptance, because the new surgical techniques and costs are generally lower than those involved in ordinary hospitalization. Cataract surgery serves as a proxy indicator of the trend towards day surgery hospitalization in Italy and, therefore, of regional variability in health-care delivery and cost. The aim of this study was to update the diffusion of cataract day surgery through various surgical ophthalmological centers in central and southern Italy during 2005. METHODS:A two-stage stratified cluster sampling method was used to draw a sample of Cataract Surgery Unit from Ophthalmic Units of central and southern Italy. A questionnaire was sent to 25 cataract surgery centers in nine health districts that represented the range of establishments (public, private, accredited or otherwise) in which cataract surgery is performed. Data were collected on numbers of procedures performed in 2005, hospital admission type, time from the onset of cataract day surgery, surgical procedure, and presence of other surgical centers. RESULTS:The response rate was 42% (10 surveys), resulting in at least one completed questionnaire for each of these 9 districts. There is a positive trend towards day surgery hospitalization in all surgical centers. The percentage of patients treated as outpatients during 2005 varied from 50-60% (Avellino, Naples, Campobasso), to 80-90% (Rome, Bari), up to 90-100% (Catania, Palermo, Siracusa and Trapani), with an increasing trend in all the centers studied. Few differences were found in surgical procedures, and these were statistically insignificant. CONCLUSION:Our results confirm a positive trend towards day surgery in place of hospital inpatient admission for cataract surgery. This trend is expected to close the existing regional gap in Italy. Increased efficiency is an overriding need for the National Health Service in order to improve the rationalization of resources.
10.1186/1472-6963-7-16
[Trends in ambulatory surgical procedures in Catalonia (Spain), 2001-2011].
Vergara Francesca,Freitas Ramírez Adriana,Gispert Rosa,Coll José J,Saltó Esteve,Trilla Antoni
Gaceta sanitaria
OBJECTIVE:To analyse the trend in ambulatory surgery procedures in Catalonia (Spain) hospitals with regard to the activity in inpatient care units and structural resources in surgery. METHODS:A descriptive study was performed using data from the Statistics of Health Facilities with Inpatient Care of the Health Department of the Catalan Government from 2001 to 2011. Data from acute care hospitals were analysed and were classified in public and private hospitals. DISCUSSION:The percentage of ambulatory surgical procedures increased by 63.2% and the percentage of inpatient surgery decreased by 23.5% (this trend was more pronounced in public hospitals). This result coincided with a decrease of structural resources in surgery (beds and operating rooms) and with an improvement in inpatient surgical activity (a decrease in the mean length of stay and bed occupancy rate in all hospitals). Structural surgery resources were optimized and efficiency was improved in surgery inpatient care units.
10.1016/j.gaceta.2015.06.006
Clinical practice and routines for day surgery in Sweden: results from a nation-wide survey.
Segerdahl M,Warrén-Stomberg M,Rawal N,Brattwall M,Jakobsson J
Acta anaesthesiologica Scandinavica
BACKGROUND:Day surgery has expanded considerably during the last decades. Routines and standards have developed but differ between and within countries. METHODS:We studied the practice of day surgery in Sweden by an extensive questionnaire survey sent to all 92 hospitals. RESULTS:The proportion of day surgery vs. in-hospital procedures was overall 43%, with 43% in adults and 46% in children. Orthopaedic (33%), general (29%) and gynaecological (17%) surgery were the most common ambulatory procedures. Most patients (>90%) underwent pre-operative assessment by an anaesthesiologist. Patient self-assessment questionnaires were common (86%). Risk stratification for post-operative nausea and vomiting was used by 70% of the departments. Anxiolytic pre-medication was uncommon. Most anaesthesiologists (95%) used pre-operative oral analgesics to initiate post-operative analgesia, the most common being paracetamol (95%), NSAIDs (73%) and coxibs (15%). A balanced general anaesthesia technique was preferred. Post-operatively, 93% of the units routinely assessed patients' pain. Analgesic combinations of paracetamol, NSAIDs and weak opioids were used by 94% of the units. Most hospitals (80%) had standardised discharge criteria based on clinical assessment, and many required a patient escort at home for 24 h post-operatively. Assessments of unplanned admission, re-admission and post-operative complications were not performed routinely. Follow-up telephone calls within 1-2 days were performed regularly in about 40% of the units, or in selected patients only (37%). Pain was the most frequent complaint on follow-up. CONCLUSIONS:In Sweden, a high degree of standardised regime for day surgical practice was found. Post-operative pain is the most common complaint after discharge.
10.1111/j.1399-6576.2007.01472.x
Factors Hindering Practice of Day Care Surgery in a Tertiary Care Centre in Southern India: A Patient's Perspective.
Vijayakumar Chellappa,Elamurugan T P,Sudharsanan Sundaramurthi,Jagdish Sadasivan
Journal of clinical and diagnostic research : JCDR
INTRODUCTION:Day care surgery offers cost containment, effective usage of hospital beds, reduced incidence of nosocomial infection and early recovery in home environment. In developing countries like India, there are various factors that influence the success of day care surgery. AIM:To assess the factors hindering the practice of day care surgery in a tertiary care centre in South India. MATERIALS AND METHODS:This observational study was conducted in the Department of General Surgery, JIPMER, Puducherry, India, from January 2013 to March 2014. All male patients with uncomplicated inguinal hernia who were admitted for elective surgery under one particular surgery unit and who were found fit for discharge on Postoperative Day 1 (POD1) based on clinical fitness were included in the study. A questionnaire containing the patient's acceptance decision, VAS (Visual Analogue Scale) pain score and the reason for non acceptance if any was used for assessment. RESULTS:Among the 89 patients who were fit for discharge on POD1, the decision for discharge was accepted by 57 patients. 32 patients were not satisfied of the decision for discharge on POD1. The common reasons for dissatisfaction with the decision were persistent pain at operated site (13 patients with mean VAS score 8.3), non availability of health care resources in their locality (12 patients) and unwillingness to travel on POD1 (four patients). CONCLUSION:A comprehensive and well presented preoperative counselling along with an effective primary health service would help in promoting day care surgery in developing countries.
10.7860/JCDR/2017/25445.10076
Paediatric day surgery: revisiting the University Hospital of the West Indies experience.
Scarlett M,Crawford-Sykes A,Thomas M,Duncan N D
The West Indian medical journal
Day surgery is cheaper and allows for less time delay. In developing countries with limited health budgets, these factors lead to higher patient turnover and shortened waiting lists. The decreased psychological trauma for both parents and children is significant. Paediatric day surgery (PDS) has been done at the University Hospital of the West Indies (UHWI) for over 40 years. A total of 975 paediatric general surgical (PGS) procedures were performed on 963 patients at the UHWI during the four-year period, January 2001 to December 2004. Paediatric day surgery numbered 727 (74.6%). Males outnumbered females 2:1, the age range was 2 weeks to 15 years, with an average age of 4 years. Ninety-seven (13.3%) of these patients were less than six months old, including eight neonates. One hundred and forty-five (20%) had more than one surgical procedure. Most children, 314 (43.2%) had inguinal hernia repair. Umbilical/supra-umbilical/epigastric herniorrhaphy (20.1%) was the next most frequently performed procedure, followed by circumcision (13.3%) and orchidopexy (5.9%). Ninety per cent of these patients were discharged home within 2-4 hours after surgery. Unplanned admissions were 2.1% of the cases. These were due to age, unplanned extensive surgical procedure, drug reaction and fever There was no mortality in this study population. This review showed that the number of PDS has increased from 60% in 1984 to 75%. These procedures were performed safely with a low complication rate. Further expansion of the service is recommended.
Day surgery: are we transferring the burden of care?
Udo I A,Eyo C S
Nigerian journal of clinical practice
CONTEXT:Day procedures are preferred by many surgeons for minor and intermediate procedures in fit patients. It is however considered to transfer the burden of care to care-givers and other healthcare providers. AIM:The aim of the following study is to assess the tendency of day care patients seeking attention from health care providers and their ability to ambulate in the first week. SETTINGS AND DESIGN:Prospective study in a tertiary health facility in South-South Nigeria. MATERIALS AND METHODS:Patients in American Society of Anesthesiologists class I and II undergoing day-care procedures in a surgery unit were assessed at one week for the effects of the procedure on ambulation and their likelihood to seek medical attention. Data on the sex, type of procedure, pain, bleeding and ambulation was analyzed. A visual analog pain score of 0- 3 (mild); 4-6 (moderate) and 7-10 (severe) was used. Bleeding was defined as complete soaking of the two-layered gauze dressing with blood. STATISTICAL ANALYSIS:Analysis was performed with SPSS 17 for Windows (SPSS Inc. Chicago, Illinois) and presented as percentages, mean and tables. RESULTS:A total of 99 patients comprised of 47 males and 52 females registered in the study; with a mean age of 38 years (range 16-70); 76 patients (77%) complained of pain at the operation site while 23 (23%) had no complaints. Pain was mild in 59 (78%) and moderate 17 (22%). None had severe pain or bleeding from the operation site; 85 patients (86%) could ambulate easily, 14 (14%) partially and none completely unable to ambulate. CONCLUSION:Day procedures in selected patients has minimal affects on their ambulation and no increased risk of seeking medical attention in the first week and would appear not to transfer the burden of care to the community.
10.4103/1119-3077.134052
The day surgery experience from the perspective of service users.
McCloy Oonagh,McCutcheon Karen
British journal of nursing (Mark Allen Publishing)
Although health policy would suggest that day surgery is the best service for patients undergoing a surgical procedure, it is important to consider the patient and whether this type of service is what they want. This information can be generated through a service evaluation with the results used to inform local decision-making, changes to care delivery and improvements in patient care. This article describes the results of a service evaluation performed in a single-site day surgery unit.
10.12968/bjon.2016.25.13.736
Operation and organisation of ambulatory surgery in France. Results of a nationwide survey; The OPERA study.
Beaussier Marc,Albaladejo Pierre,Sciard Didier,Jouffroy Laurent,Benhamou Dan,Ecoffey Claude,Aubrun Frederic,
Anaesthesia, critical care & pain medicine
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.
10.1016/j.accpm.2017.07.003
Day surgery in Finland: a prospective cohort study of 14 day-surgery units.
Mattila K,Hynynen M,
Acta anaesthesiologica Scandinavica
BACKGROUND:Day surgery is an established practice for elective operative care, and is considered safe and cost-effective in several procedures and for several patients. At present, day-surgery accounts for approximately 50% of elective surgery in Finland. The aim of this study was to prospectively describe the present situation at Finnish day-surgery units, focusing on the quality of care. METHODS:Fourteen large- to medium-sized day surgery and short-stay units were recruited, and all patient cases performed during a 2-month study period were registered and analyzed. Quality of care was assessed by analyzing the rates and reasons for overnight admission, readmission, reoperation, and cancellations. Satisfaction of care was inquired from day-surgery patients during a 2-week period. Head anesthesiologists were interviewed about functional policies. RESULTS:Of 7915 reported cases, 84% were day surgery. Typically, several specialties were represented at the units, with orthopedics accounting for nearly 30% of all day-surgery procedures. Patient selection criteria were in line with the present-day recommendations, although the proportion of older patients and the ASA physical status 3 patients were still relatively low. The rate of unplanned overnight admissions was 5.9%. Return hospital visits were reported in 3.7% and readmissions in 0.7% of patients 1-28 days post-operatively. Patient satisfaction was high. CONCLUSION:Along with the growing demand for day surgery, Finnish public hospitals have succeeded in providing good-quality care, and there still seems to be potential to increase the share of day surgery. Easily accessible benchmarking tools are needed for quality control and learning from peers.
10.1111/j.1399-6576.2008.01895.x
National survey of the provision of day surgery across public and private hospitals in Ireland.
Cowman S,Gethin G,Mulligan E,Ryan K,Meshkat B
Irish journal of medical science
BACKGROUND:Day surgery (DS) is viewed as the optimal environment for many surgical procedures. Yet, Irish DS rates are low compared to international figures. AIMS:To describe the current provision of DS in Ireland and to identify barriers to its expansion. METHODS:Thirty-seven public hospitals and 17 private hospitals providing DS were surveyed during July/August 2009. RESULTS:Thirty-seven hospitals replied (67%) (30 public, 7 private). DS beds ranged from 3 to 39. Fourteen (38%) had dedicated DS units, and no unit had a consultant in charge. Twenty-one (57%) provided pre-assessment with 36 (96%) providing patient information leaflets both pre- and post-operatively. Stay-in rate was less than 5%. Eight units had reviewed the adverse event rates following DS. Seven barriers to optimizing DS were identified, the main one being lack of dedicated DS theatres.
10.1007/s11845-010-0562-7
Day Surgery Program at West China Hospital: Exploring the Initial Experience.
Jiang Lisha,Houston Rebecca,Li Chao,Siddiqi Javed,Ma Qingxin,Wei Shanzun,Ma Hongsheng
Cureus
Healthcare facilities in China are facing increasing demands as the country has the fastest aging populations in the world. Day surgery can be utilized to address some of these demands. Benefits of day surgery include shortened hospital stay, decreased risk of hospital-associated infections, and increased cost efficiency. We present a retrospective study of eight years of day surgery data from West China Hospital, one of the largest hospitals in China, with an emphasis on an examination of the growth in day surgeries. We examined patterns of utilization of day surgery versus inpatient surgery (including types of surgeries performed in the Day Surgery Center and the ratio of day surgery versus elective surgery), as well as unplanned readmission and return to inpatient department rates, and a comparison of average costs and length of stay for day surgery versus hospital surgery. Day surgery has a safe and cost-effective way to alleviate the soaring healthcare demands in West China. There is potential opportunity to further address the ever-increasing demands on the healthcare system in this area by performing more complex surgeries as day surgeries. This article presents an effective organizational protocol and proposes a reliable medical quality assurance system, which prioritizes safety of the growing day surgery program; furthermore, it describes the factors and lessons learned from the successful implementation of a day surgery system.
10.7759/cureus.8961
Patient and staff satisfaction with 'day of admission' elective surgery.
Sofela Agbolahan A,Laban James T,Selway Richard P
British journal of neurosurgery
OBJECTIVES:To evaluate patient and staff satisfaction with day of admission surgery in a neurosurgical unit and its effect on theatre start times. METHODS AND DESIGN:Patients were admitted to a Neurosciences admission lounge (NAL) for neurosurgery on the morning of their operation if deemed appropriate by their neurosurgical consultant. All patients in the NAL were asked to complete patient satisfaction questionnaires. Staff members involved in the care of these patients also completed a satisfaction questionnaire. Theatre start times were compared with those whose patients had been admitted prior to the day of surgery. 378 patients admitted on the day of surgery, 16 doctors (5 anaesthetists, 7 neurosurgeons and 4 neuro high dependency unit, HDU doctors) and 5 nurses. Patients completed an anonymised emotional mapping patient satisfaction questionnaire, and short interviews were carried out with staff members. Theatre start times were obtained retrospectively from the theatre database for lists starting with patients admitted on the day of surgery, and lists starting with patients admitted prior to the day of surgery. RESULTS:83% of patients felt positive on arrival in the NAL and 88% felt positive on being seen by the doctors and nurses prior to surgery. Overall 79% of patients gave positive responses throughout their patient pathway. 90% of staff were positive about day of admission surgery and all staff members were satisfied that there were no negative effects on surgical outcome. Theatre start time was on average 27 minutes earlier in patients admitted on the day of surgery. CONCLUSIONS:Neurosurgical patients, appropriately selected, can be admitted on the day of surgery with high staff and patient satisfaction and without delaying theatre start times.
10.3109/02688697.2012.725872
Day-surgery and surgical waiting time.
Caldinhas Paula Maria,Ferrinho Paulo
Revista brasileira de epidemiologia = Brazilian journal of epidemiology
UNLABELLED:Surgical waiting time remains an important issue regarding access to health care provision. It is considered to be excessive in most OEDC countries (over twelve weeks or ninety days). The development of day surgery has been one of the strategies that proved effective in reducing surgical waiting time. This study aims to establish a correlation between surgical waiting time and the percentage of day-surgery cases, in hospitals with surgical services, in the Portuguese National Health Services, during 2006. METHODOLOGY:An observational, analytical and ecological study was conducted to establish the correlations existing between surgical waiting time and the percentage of day-surgery procedures realized, as well as associations with other variables, through multivariate and correlation analysis. RESULTS:A negative, statistically significant Spearman's correlation was observed between the percentage of day-surgery cases and the waiting surgical time for eletive procedures.
10.1590/S1415-790X2013000200008
[Ordinary hospitalisation, day surgery and one-day surgery: appropriateness and economic considerations in the DRG era].
Porcellini Alessandra,Ventura Pasquale,Federico Luca
Chirurgia italiana
Italian Law No. 502 dated 1992 regarding the "Reorganisation of the Discipline in Matters of Public Health" and the introduction of the DRG (diagnosis-related groups) system in Italy in 1993 were very important steps in the establishment and implementation of the Management and Economic Autonomy of Hospitals. Since 1/1/2003, in the Lombardy Region, the Italian Version of the ICD-9-CM (International Classification of Diseases--9th revision--Clinical Modification 2002), published by the Lombardy Region itself in December 2002, has been in experimental use for the evaluation of DRGs. Since 1/1/2007 the annually updated hospital tariff system has been in use for the remuneration of acute surgical DRGs of specific interest for activity in the day surgery/one-day surgery setting versus ordinary hospitalisation. The previous regulations, which, in fact, prescribed that a sum equal to 75% of the entire value of the DRG treated in the ordinary hospitalisation setting be remunerated, has been revised in relation to certain diseases. In the present study we consider two different groups of DRGs pertaining to acute surgical diseases: DRGs remunerated equally for all three kinds of hospitalisation, and DRGs remunerated differently in day surgery/one-day surgery versus ordinary hospitalisation. From our experience it emerges that the percentage of elective operations in the short hospitalisation setting versus ordinary or 5% deferred emergency hospitalisation has stabilised around 20-25% in the two last years. Computerisation of waiting lists has also contributed to reducing mean waiting times, at the same time increasing the total number of operations per year.
Day surgery: Results after restructuration of a university public general surgery unit.
Gaucher S,Cappiello F,Bouam S,Damardji I,Aissat A,Boutron I,Béthoux J P
Journal of visceral surgery
INTRODUCTION:Nowadays, in France, development of the ambulatory surgery has stalled. This is probably related to the fact that ambulatory surgery is restricted by the law to the "day surgery" in 12 hours, and only 17 procedures are referenced for this surgery. Thus, conventional hospitalization remained the rule after surgery. In January 2010, our university general surgery unit was restructured. It evolved from a conventional unit to a predominantly ambulatory unit. Otherwise, our unit adjoins a hotel, even inside our institution, which accommodates patients, patient visitors and tourists. AIM:The aim of this retrospective study was to compare the postoperative accommodation modalities between two groups of patients. The first group consisted of patients admitted before January 2010, at the time of conventional activity, whereas the second group consisted of patients admitted after January 2010 in a restructured unit. METHODS:Inclusion of patients admitted from April 1, 2008 to March 31, 2009 (conventional hospitalization period) and from April 1, 2010 to March 31, 2011 (ambulatory management period), scheduled for one single surgical procedure excluding emergency. RESULTS:A total of 360 patients were retained: 229 for the conventional period and 131 for the ambulatory period, with a median age of 55 (range 15-87). No statistically significant difference was noted between the two groups as concerned median age, gender or ASA status. The number of postoperative nights varied significantly between the two groups with a mean of 3.8 nights (median three nights, range 0-32) for the conventional period versus 0.4 nights (median 0 night, range 0-10) for the ambulatory period (P<0.0001 by the unadjusted Mann-Whitney test and P<0.0001 by the Wald test [with adjustment]). DISCUSSION:Our results show that it is clearly possible to distinguish the need for care of the need for accommodation and significantly reduce postoperative conventional accommodation. They also raise the question of extending the legal period of 12 hours to 24 hours in order to expand the list of the referenced procedures.
10.1016/j.jviscsurg.2013.03.002
[The organization and rendering of ambulatory surgical medical care to the population of the Russian Federation].
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsiny
The article deals with the results of analysis of official statistic data concerning the rendering of ambulatory surgical care to the population of the Russian Federation. The main volumes of surgical care rendered to the population (including children) in ambulatory polyclinic institutions, day-time in-patient establishment of ambulatory polyclinic institutions are demonstrated. The structure of ambulatory surgical operations according the localization and applied medical equipment is analyzed. The research data testify the necessity of further development of organization and rendering of ambulatory surgical care including enhancement of its significance, availability and effectiveness at the expense of reallocation of surgical care volumes to the ambulatory stage.
Day surgery: how far can we go and are there still any limits?
Qadir Nusrath,Smith Ian
Current opinion in anaesthesiology
PURPOSE OF REVIEW:Day surgery continues to be a popular form of care, and patients and procedures of ever-increasing complexity are now being considered. As previous restrictions are regularly swept away, it is reasonable to ask where the new limits are and whether there are still any absolute contraindications to day surgery. RECENT FINDINGS:Recent evidence provides confirmation that some of the more complex, minimally invasive surgical procedures, such as laparoscopic nephrectomy, can safely and successfully be undertaken on a day-case basis. This transformation is clearly dependent on the development of appropriate technologies, but also involves a realistic assessment of when complications will occur and whether or not these will be prevented by an overnight hospital stay. A similar approach can be applied to the impact of various medical comorbidities, with current evidence suggesting that many predict intraoperative, but not postoperative, complications. The interactions of various factors -medical and surgical - however, may be more important. SUMMARY:Day surgery has clearly expanded beyond its previous limits, but some absolute contraindications still remain. A great deal is possible, but not everything that can be done necessarily benefits patients and some cases may only be feasible in expert hands and in ideal conditions.
10.1097/ACO.0b013e3282f0320e
Evidence-based medicine in day surgery.
Gupta Anil
Current opinion in anaesthesiology
PURPOSE OF REVIEW:To present the evidence available for the management of pain, for the prevention of nausea and vomiting, and for the best anaesthetic technique during ambulatory surgery. RECENT FINDINGS:Paracetamol and nonsteroidal anti-inflammatory drugs are effective analgesics with a low number needed to treat, and are recommended when not contraindicated. Droperidol, dexamethasone and ondansetron are equally effective in the prevention of postoperative nausea and vomiting during ambulatory surgery. The choice of the anaesthetic technique appears to play a minor role in recovery from anaesthesia or in the occurrence of minor postoperative complications or home discharge, except for the use of total intravenous anaesthesia for the prevention of postoperative nausea and vomiting. SUMMARY:Pain should be prevented adequately and treated vigorously. Postoperative nausea and vomiting is common and should be prevented in the at-risk patient. The choice of inhalation agents during ambulatory surgery is of minor importance in recovery from anaesthesia.
10.1097/ACO.0b013e3282f021c9
Day surgery visits for dental problems.
Quiñonez Carlos,Gibson Debbie,Jokovic Aleksandra,Locker David
Community dentistry and oral epidemiology
OBJECTIVES:To fill an information gap for dental care policy stakeholders in Canada, this pilot study explored the nature of day surgery (DS) visits for dental problems in Ontario, the country's largest province. METHODS:The Canadian Institute for Health Information's National Ambulatory Care Reporting System was used, which contains demographic, diagnostic, procedural and administrative information for ambulatory care settings across Ontario. Fiscal years 2003/2004 to 2005/2006 data were included for DS visits that had a main problem coded with an International Classification of Diseases code in the range K00-K14, representing diseases of the oral cavity, salivary glands and jaws. RESULTS:During this period, approximately 75 791 persons made 79 133 DS visits for dental problems in Ontario. Proportionally, children under 5 years of age with dental caries represent the majority of DS visits. Restorations and extractions were the most frequently performed DS care procedure. CONCLUSIONS:This is the first study of its kind in Canada, and confirms many of the assumptions held about DS care for dental problems. The study also acts as a baseline for ongoing quality improvement and planning within the province of Ontario.
10.1111/j.1600-0528.2009.00498.x
Comparative study of feasibility of day-care surgery in rural and urban patients.
Zaidi Abbas Ali,Zahra Tasneem
Journal of clinical and diagnostic research : JCDR
BACKGROUND:Day-care surgery is a common procedure in most of the hospitals. It has the advantages of early discharge and thus contributes to cost effectiveness. OBJECTIVES:The aim of this study was to compare the feasibility of day-care surgery in rural and urban patients. MATERIAL AND METHODS:Around 200 cases undergoing day-care surgeries of various types in urban and rural patient were enrolled randomly in the study. RESULTS:The maximum number of patients in both the groups were between the range of 21-40 years. The most frequent surgery in rural group was dilatation and curettage (25%) and in urban group was herniotomy (20%). In follow up only 1% complication occurred in rural group with 6% patients were lost in follow up and 4% changed the treatment center. In urban patients follow up was uneventful. The urban group people were more educated than the rural group. CONCLUSION:Day-care surgery is overall a beneficial procedure but understanding of the patient regarding the surgery and importance of follow up according to educational standard and intellectual status are very important criteria.
10.7860/JCDR/2013/6983.3598
[Possibilities of outpatient surgery].
Belevitin A B,Vorob'ev V V,Bezuglyĭ A V,Davydov D V,Ovchinnikov D V
Khirurgiia
The main types of hospital-substituting technologies, their material and technical basis and possibilities of outpatient medical help are described in the article. Suggestions concerning further development of hospital-substituting technologies are presented by second congress of Russian outpatient surgeons.
Implementation of day of surgery admission for rectal cancer surgery in Ireland following a national centralisation programme.
Stephens Ian,Murphy Claudine,Reynolds Ian S,Sahebally Shaheel,Deasy Joseph,Burke John P,McNamara Deborah A
Irish journal of medical science
BACKGROUND:Centralisation of rectal cancer surgery has altered the delivery of colorectal cancer care in Ireland. This has resulted in an increased demand for elective surgical beds in designated centres. AIM:This study aimed to assess if day of surgery admission (DOSA), in conjunction with implementation of a coordinated enhanced recovery pathway can reduce length of stay following elective rectal cancer resection. METHODS:This is a retrospective review from a single institution. Our prospectively maintained Dendrite® Database was interrogated. Three time points were analysed across a 7-year period (2011, 2012, 2016). The first predates the introduction of a dedicated DOSA programme, the next was directly thereafter, and the final was 5-years post-implementation. These dates coincide with the centralisation of rectal cancer surgery to this centre. Outcomes included unadjusted length of stay and rates of DOSA pre-and post-implementation of the programme. RESULTS:The introduction of a DOSA pathway resulted in a fivefold increase in day of surgery admissions and a related 3-day reduction in average length of stay within a single year of implementation. This further improved in 2016, showing an almost 83% increase (15.90-98.50%) in day of surgery admission and a reduction in average length of stay from 16.4 to 12.4 days when compared to 2011. CONCLUSIONS:Despite an increase in caseload of 54%, an estimated 272 bed days were saved. This demonstrated that DOSA is sustainable and highly effective in tackling the increased inpatient bed demands associated with the growing requirement for elective surgery.
10.1007/s11845-018-1904-0
[Day surgery: recommendations, tools and feedback].
Bontemps Gilles
Soins; la revue de reference infirmiere
The ANAP (French agency for supporting medical institutions' performance) has the legal responsibility to provide tools and recommendations and to support institutions in improving their organisational performance. In the context of the public authorities' push for day surgery, the ANAP has specifically addressed this issue, gathering feedback from French and European health institutions.
Children in day surgery: clinical practice and routines. The results from a nation-wide survey.
Segerdahl M,Warrén-Stomberg M,Rawal N,Brattwall M,Jakobsson J
Acta anaesthesiologica Scandinavica
BACKGROUND:Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking. METHODS:We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail. RESULTS:The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1-6-year-olds, and in 7-16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1-6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1-3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy. CONCLUSIONS:In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.
10.1111/j.1399-6576.2008.01669.x
[Nursing workload in Day Surgery].
Bulfone Giampiera,Dell'Aglio Agostino,Rizzato Mariuccia,Conte Luigi
Professioni infermieristiche
The "workload" is defined as the whole of the activities completed by a group of professionals in a period of time. The different conceptualization of nursing workload has determined different methods and tools of evaluation. The aim of this study is to evaluate the nursing workload in a Day Surgery Unit with a quantitative (time in activities) and qualitative approach (perceived complexity). We want analyze also every correlation with the time in the activities. The study design is observational. We have analyzed 147 patients admitted to the Day Surgery Unit of a University Hospital in Italy. The nurses have dedicated the average of 164,8 minutes in care. The nursing care time is correlated to anesthesiological risk class and to the general surgery procedure. The patients in specialistic surgery are considered more complexes from the nurses then the general surgery patients. Another indicator associated to the high perceived complexity is the "comorbidity management". This study will help to manage nursing resources and the admission of the patients.
Day surgery, variations in routines and practices a questionnaire survey.
Stomberg Margareta Warrén,Brattwall Metha,Jakobsson Jan G
International journal of surgery (London, England)
BACKGROUND:Day surgery is expanding however little is known about every day practice and routines. METHODS:A web-based questionnaire including 34 questions with fixed multiple choice responses around routine and practice for the perioperative handling of patients scheduled for day case surgery was send to 100 hospitals. RESULTS:There was an overall response rate of 70%. Most centres had a dedicated day surgery unit (87%). Preoperative assessment routines, when, how and by whom varied. Patient self-assessment questionnaires were common practice (87%). Upper age limit was uncommon (10%), lower age limit common (77%), and fixed high body mass index-limitation showed a mixed pattern, mean 40%. Postoperative nauseas and vomiting-risk stratification varied mean 46%. Anxiolytic premedication was uncommon. Administration of oral analgesics varied, mean 70%; paracetamol (94%), NSAIDs (80%) and opioid (28%). Preferred general anaesthesia technique varied considerable. Laryngeal mask airway was consistently used. Management of pain while in hospital was consistently performed. A majority centres provided take-home analgesics "tablet-package" (69%) or as prescription (80%). Strong opioids to be taken at home were given or prescribed by 59% of units. Written information about the postoperative care was common practice (90%), written instruction about management of pain was less frequently provided (69%). Most hospitals (93%) had standardised discharge criteria, including demand of an escort (75%) and not being alone first postoperative night (81%). CONCLUSIONS:We found that regime for day surgical anaesthesia practice varied between as well as within countries. There is obvious room for further research on how to achieve safe and cost-effective logistics and practice for day case surgery.
10.1016/j.ijsu.2012.12.017
[Indicators of healthcare quality in day surgery (2010-2012)].
Martínez Rodenas F,Codina Grifell J,Deulofeu Quintana P,Garrido Corchón J,Blasco Casares F,Gibanel Garanto X,Cuixart Vilamajó L,de Haro Licer J,Vazquez Dorrego X
Revista de calidad asistencial : organo de la Sociedad Espanola de Calidad Asistencial
INTRODUCTION:Monitoring quality indicators in Ambulatory Surgery centers is fundamental in order to identify problems, correct them and prevent them. Given their large number, it is essential to select the most valid ones. OBJECTIVES:The objectives of the study are the continuous improvement in the quality of healthcare of day-case surgery in our center, by monitoring selective quality parameters, having periodic information on the results and taking corrective measures, as well as achieving a percentage of unplanned transfer and cancellations within quality standards. MATERIAL AND METHOD:Prospective, observational and descriptive study of the day-case surgery carried out from January 2010 to December 2012. Unplanned hospital admissions and cancellations on the same day of the operation were selected and monitored, along with their reasons. Hospital admissions were classified as: inappropriate selection, medical-surgical complications, and others. The results were evaluated each year and statistically analysed using χ(2) tests. RESULTS:A total of 8,300 patients underwent day surgery during the 3 years studied. The day-case surgery and outpatient index increased by 5.4 and 6.4%, respectively (P<.01). Unexpected hospital admissions gradually decreased due to the lower number of complications (P<.01). Hospital admissions, due to an extended period of time in locoregional anaesthesia recovery, also decreased (P<.01). There was improved prevention of nausea and vomiting, and of poorly controlled pain. The proportion of afternoon admissions was significantly reduced (P<.01). The cancellations increased in 2011 (P<.01). CONCLUSIONS:The monitoring of quality parameters in day-case surgery has been a useful tool in our clinical and quality management. Globally, the unplanned transfer and cancellations have been within the quality standards and many of the indicators analysed have improved.
10.1016/j.cali.2014.01.006
Systematic review of day surgery for breast cancer.
Marla S,Stallard S
International journal of surgery (London, England)
BACKGROUND:Over the last decade, breast cancer surgery has become less invasive and potentially suitable for day surgery. The aim of this systematic review was to establish the benefits and disadvantages of day surgery for breast cancer. METHODS:A systematic search of the Cochrane Library, Medline, British Nursing Index, CINAHL, EMBASE and PsycINFO was carried out. All relevant papers were assessed for their methodological quality using a checklist designed to assess both randomised and non-randomised studies with specific questions added to address outcome measures. RESULTS:No randomised controlled trials were found in literature. Eleven observational studies were included. The rate of discharge after day surgery was universally high with very low acute readmission rates. Intractable vomiting, patient anxiety and pain control were the main reasons for failing discharge. Patient satisfaction with day surgery was high and psychological recovery was quicker, however, majority of the studies did not use validated questionnaires. The hospital costs were lower for day surgery. CONCLUSIONS:Day surgery for breast cancer is safe, with equivalent complication rates, but there is lack of evidence from randomised controlled trials. Patient satisfaction and psychological well-being is high. Further trials with validated questionnaires are required to confirm this.
10.1016/j.ijsu.2009.04.015
Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures.
Majholm B,Engbæk J,Bartholdy J,Oerding H,Ahlburg P,Ulrik A-M G,Bill L,Langfrits C S,Møller A M
Acta anaesthesiologica Scandinavica
BACKGROUND:Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort. METHODS:We prospectively recorded data from 57,709 day surgery procedures performed in eight day surgery centres over a 3-year period. We cross-checked with the National Patient Registry to identify complications 0-30 days post-operatively, and registrations from The Danish Register of Cause of Death were requested. We retrieved the records of 1174 patients to assign a relation between secondary contact and day surgery. RESULTS:The overall rate of return hospital visits was 1.21% [95% confidence interval (CI): 1.12-1.30%] caused by a wide range of diagnoses. No deaths were definitely related to day surgery. The return hospital visits were due to haemorrhage/haematoma 0.50% (95% CI: 0.44-0.56%), infection 0.44% (95% CI: 0.38-0 49%) and thromboembolic events 0.03%. Major morbidity was rare. The surgical procedures with the highest rate of complication were tonsillectomies 11.4%, surgically induced abortions 3.13% and inguinal hernia repairs 1.23%. CONCLUSION:This large-scale Danish national study confirmed that day surgery is associated with a very low rate of return hospital visits. Despite the rapid expansion of day surgery, safety has been maintained, major morbidity being very rare, and no deaths being definitely related to day surgery.
10.1111/j.1399-6576.2011.02631.x
Slovakia health system review.
Szalay Tomás,Pazitný Peter,Szalayová Angelika,Frisová Simona,Morvay Karol,Petrovic Marek,van Ginneken Ewout
Health systems in transition
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services, and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Slovak health system is a system in progress. Major health reform in the period 2002 to 2006 introduced a new approach based on managed competition. Although large improvements have been made since the 1990s (for example in life expectancy and infant mortality), health outcomes are generally still substantially worse than the average for the EU15 but close to the other Visegrad Four countries. Per capita health spending (in purchasing power parity [PPP]) was around half the EU15 average. A large share of these resources was absorbed by pharmaceutical spending (28% in 2008, compared to 16% in OECD countries). Some important utilization indicators signal plenty of resources in the system but may also indicate excess bed capacity and overutilization. The number of physicians and nurses per capita has been actively reduced since 2001 but remains above the average of the EU12 (i.e. the 12 countries that joined the EU in 2004 and 2007). An ageing workforce and professional migration may reinforce a shortage of health care workers. People have free choice of general practitioner (GP) and specialist. Their services are provided without cost-sharing from patients, with the notable exception of dental procedures. Inpatient care and specialized ambulatory care are provided in general hospitals and specialized hospitals. Pharmaceutical expenditure per capita accounts for one-third of public expenditure on health care. Long-term care is provided by health care facilities and social care facilities. Slovakia has a progressive system of financing health care. However, the health reforms of 2002 to 2006 led to an increase in the number of households that contributed more from their income and the distributive impacts were not equitable. This was mainly caused by the introduction of a reference pricing scheme for pharmaceuticals. Some key challenges remain: improving the health status of the population and the quality of care while securing the future financial sustainability of the system.
Day case surgery: experience in a tertiary health institution in Nigeria.
Fadiora S O,Kolawole I K,Olatoke S A,Adejunmobi M O
West African journal of medicine
BACKGROUND:Previous studies on day case surgery in Nigeria have focused mainly on the immediate peri-operative care of the patients within the service hospital. OBJECTIVE:To assess patients' satisfaction and postoperative complications within the first seven days following day case surgery. METHODS:A post discharge patient's survey was conducted on the 7th Postoperative day in 102 consecutive patients who had undergone day care surgery. Patients were interviewed about their postoperative experiences, type of complications and treatment applied, and visits to hospitals or community health facilities/providers. They were also asked to comment on their satisfaction or otherwise of day case treatment. RESULTS:There were 32 occasions of treatment provided to 24 patients (23.5%) after discharge. Seventy-two patients (70.6 %) reported one or more complications, with pain being present in all of them. Some patients received treatment more than once, and for more than one complaint. Pain was the most common reason for seeking treatment. There was no mortality. Eighty-six (84.3%) patients expressed satisfaction with day case treatment, while 10 (9.8%) patients (9.8%) expressed dissatisfaction and 6 (5.9%) patients were indifferent. CONCLUSION:Day surgery provided satisfactory outcome for the majority of our patients, with low complication rates.
10.4314/wajm.v26i1.28298
[Future-oriented design of ambulatory surgery. Organizational aspects and medical options].
Möllmann M
Der Anaesthesist
Ambulatory surgery continues to grow and is slowly becoming routine in the majority of cases. Although the development of ambulatory surgery in Germany appears to be somewhat delayed, this is actually a chance to learn from worldwide experiences and avoid the mistakes others made earlier. This article investigates current trends and developments in day case surgery and discusses the extended role and influence of the anesthetist in the perioperative setting.
10.1007/s00101-011-1959-z
Variability in elective day-surgery rates between Belgian hospitals - Analyses of administrative data explained by surgical experts.
Leroy Roos,Camberlin Cécile,Lefèvre Mélanie,Van den Heede Koen,Van de Voorde Carine,Beguin Claire
International journal of surgery (London, England)
BACKGROUND:In the last decades, day surgery has steadily and significantly grown in many countries, yet the increase has been uneven. There are large variations in day-surgery activity between countries, but also within countries between hospitals and surgeons. This paper explores the variability in day-care activity for elective surgical procedures between Belgian hospitals. MATERIALS AND METHODS:The administrative hospital data of all patients formally admitted in a Belgian hospital for inpatient or day-care surgery between 2011 and 2013 were analysed and summarized in graphs. During 11 expert meetings with ad-hoc surgical expert groups the variability in day-surgery share between hospitals was discussed in depth. RESULTS:The variability in day-care share between Belgian hospitals is considerable. For 37 out of 486 elective surgical procedures, the variability ranged between 0 and 100%. High national day-care rates do not preclude room for improvement for certain hospitals as for the majority of these procedures there are "low performers". According to the consulted clinical experts, the high variability in day-care share may for the greater part be explained by medical team related factors, customs and traditions, the lack of clinical guidelines, financial factors, organisational factors and patient related factors. CONCLUSION:If a further expansion of day surgery is envisaged in Belgium the factors that contribute to the current variability in day-surgery rates between hospitals should be addressed. In addition, a feedback system in which hospitals and health care providers have the figures on their percentage of procedures carried out in day surgery compared to other hospitals and care providers (benchmarking) and the monitoring of a number of quality indicators (e.g. unplanned readmission, unplanned inpatient stay, emergency department visit) should be installed.
10.1016/j.ijsu.2017.07.075
[Day surgery: the role and training needs of nurses].
Agozzino Erminia,Naddei Maria,Schiavone Beniamino
Igiene e sanita pubblica
Medicine and health care are increasingly directed towards the achievement of high quality standards and of costs reduction. It is in this framework that same-day surgery finds its role, being able to satisfy both of the above needs. Despite its recognized benefits, in Italy this efficient model of hospitalization still meets several obstacles and the ratio of services provided in day hospital with respect to ordinary hospital admission is about 1 to 3. Day Surgery services depend on team work and the nurse's role is of utmost importance and responsibility since it involves both clinical care and managerial activities. Through a careful analysis of the skills required of a day surgery nurse, the authors discuss aspects of nurses' training in view of the pre- and post-graduate courses currently offered, including on-the-job training.
Minimum volume standards in day surgery: a systematic review.
Stanak Michal,Strohmaier Christoph
BMC health services research
BACKGROUND:The aim was to find out if and for what indications are minimum volume standards (MVS) applied in the day surgery setting and whether the application of MVS improves patient relevant outcomes. METHODS:We conducted a comprehensive systematic literature search in seven databases on July 12th, 2019. Concerning effectiveness and safety, the data retrieved from the selected studies were systematically extracted into data-extraction tables. Two independent researchers (MS, CS) systematically assessed the quality of evidence using the quality assessment tool for individual studies of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) called Task Force Checklist for Quality Assessment of Retrospective Database Studies. No instances of disagreement occurred. No further data processing was applied. RESULTS:The systematic literature search, together with hand search, yielded 595 hits. No prospective or controlled studies were found. Data from eight retrospective studies were used in the analysis of clinical effectiveness and safety on seven indications: anterior cruciate ligament reconstruction, cataract surgery, meniscectomy, thyroidectomy, primary hip arthroscopy, open carpal tunnel release, and rotator cuff repair. All interventions (except for carpal tunnel release and thyroidectomy) confirmed a volume-outcome relationship (VOR) with relation to surgeon/hospital volume, however, none established MVS for the respective interventions. Safety related data were reported without its relationship to surgeon/hospital volume. CONCLUSIONS:This present paper provides some evidence in favor of the VOR, however, it based on low quality retrospective data-analyses. The present results cannot offer any clear-cut MVS thresholds for the day surgery setting and so the simple transition from inpatient results (that support MVS) to the day surgery setting is questionable. Further quality assuring policy approaches should be considered.
10.1186/s12913-020-05724-2
[Analysis of the utilization of one-day surgery in Hungary].
Pónusz Róbert,Endrei Dóra,Kovács Dalma,Németh Noémi,Schiszler Bence,Molics Bálint,Raposa László Bence,Gulácsi László,Gamal Eldin Mohamed,Boncz Imre
Orvosi hetilap
The impact of one-day surgery has been increasing since the past few decades. This type of health service could fulfil many requirements of health policy, health care services, governments as well as patients. The aim of the research was to assess the publicly financed case numbers and interventions of one-day surgery in Hungary between 2010 and 2015 from different aspects. A retrospective and quantitative research was made, based on data of the National Health Insurance Fund of Hungary. The database contained all publicly financed one-day surgery cases (both theoretical and performed cases), intervention codes (WHO) as well as the related medical field. Then the database also contained all relevant information related to the patients (age, sex, residency according to the county) and the type of the provider health care institutions. Our results showed an increasing tendency according to the case numbers of one-day surgery from 130 995 (2010) to 251 328 (2015). The mean age of patients also increased in the analyzed period; in 2010: 47.4 years, in 2015: 54.5 years. In 2010, 42% of the theoretically defined one-day surgery cases were practically performed as one-day surgery cases which increased significantly to 65% in 2015. Gynecology, ophthalmology, general surgery and urology have had a significant impact in one-day surgery in Hungary. The analyzed data showed a significant increase of accounted cases, and we could identify the remarkable impact of gynecology and ophthalmology in one-day surgery in Hungary. Orv Hetil. 2019; 160(17): 670-678.
10.1556/650.2019.31342
[Profitability of a day hospital: analysis of activity, cost and effectiveness].
Hernando Ortiz Lili,Hinojosa Mena-Bernal Carmen,González Sarmiento Enrique,González Guilabert Isabel,Arana Ruiz Jorge,Muñoz Moreno M Fe
Gaceta sanitaria
OBJECTIVE:Day hospitals are an alternative to conventional hospital care. We analyzed the functioning and profitability of the day hospital of Hospital Clínico de Valladolid, Spain, in 2009. Profitability is expressed as the provision of identical health coverage at a lower cost than that generated by conventional hospital care and with adequate quality indicators. METHODS:We performed a retrospective, observational and descriptive study of the information obtained on each patient attended in the day hospital from January 1 to December 31, 2009. We studied four quality indicators: cancellation of meetings, the rate of transfusion reactions, the out-patient rate and the satisfaction index. The estimated savings for each process was calculated as the difference in the average cost of hospitalization minus the average cost of the process in the day hospital. RESULTS:The most frequent diseases were systemic and connective tissue diseases, accounting for 25.4% of the processes treated; of these, 17.1% corresponded to rheumatoid arthritis. Patient satisfaction was 93%. Meetings cancellations and the rate of transfusion reactions were 0%. The out-patient rate was 26%. Day hospital costs were 8.6% of conventional hospital costs, with savings of 78,390.69 euros. CONCLUSION:The day hospital is cost effective due to savings compared with conventional hospitalization and has a satisfactory quality index.
10.1016/j.gaceta.2011.09.034
[Outpatient surgery in hospital. An instrument for resource optimization?].
Frank C,Vetter S Y,Krämer P,Reitzel T,Wentzensen A,Studier-Fischer S
Der Unfallchirurg
The societies of western countries are facing enormous economic and social challenges. Despite a declining population size the number of elderly patients is growing and will lead to an increase in cases of trauma in the near future. In addition, the health care system will have to be financed by a reduced labor force. To realize the ambitious political goal of providing comprehensive medical care an economization of hospital treatment must be achieved. The bottleneck within the surgical specialties in case of efficient scheduling will be the capacity utilization of the operating theatres. Additional separate outpatient operating theatres adjacent to hospitals could be an efficient instrument for using resources and economizing medical procedures. Considering the socio-demographic alterations of our society an adequate discussion regarding the general medical conditions is essential.
10.1007/s00113-010-1792-x
Multidisciplinary day surgery unit: seven years' experience.
Leardi Sergio,Pietroletti Irenato,Angeloni Gianfranco,Ciofani Emilio,De Blasis Giovanni,Di Bastiano Walter
Chirurgia italiana
The autonomous multidisciplinary day surgery unit is the gold standard for day surgery procedures. The Authors report their experience with the Pescina Hospital autonomous multidisciplinary day surgery unit (Avezzano Heath Authority, University of L'Aquila). In total, 4140 patients were enrolled to the day surgery setting from 2001 to 2007. Age, gender and ASA of patients, type of disease, surgery, anaesthesia and the usual day surgery activity quality indices (cancellation and delays of operations, postoperative pain and nausea or vomiting, postoperative morbidity, discharge and early readmission) were evaluated. 4046 patients underwent day surgery (orthopaedic 29.8%, general surgery 26.2%, ophthalmology 21.6%, vascular surgery 19.8%, miscellaneous 2.6%). Rates of cancelled and delayed operations were 2.3% and 2.4%, respectively. Local anaesthesia was performed in 54.3% of operations. None of the patients reported postoperative nausea and vomiting. Severe postoperative pain was present in 10% of cases. 77% of patients was discharged within four hours of surgery, and the others within six hours. Four patients (0.11%) were readmitted early. The postoperative morbidity and mortality rates were 0.49% and 0%, respectively. None of the postoperative events correlated with gender, age, ASA, or type of surgery and anaesthesia. The multidisciplinary day surgery unit, with dedicated medical and nursing staff and suitable organisation such as ours is characterised by favourable surgery activity quality indices and good patient outcomes.
Patients' perceptions of day surgery: a survey study in China surgery.
Yu W P,Chen Y,Duan G M,Hu H,Ma H S,Dai Y
Hong Kong medical journal = Xianggang yi xue za zhi
OBJECTIVE:To investigate patients' perceptions of day surgery, specifically their convenience; social, functional and economic values; risk perceptions; and patient satisfaction. DESIGN:Cross-sectional questionnaire survey. SETTING:West China Hospital in Chengdu City, China. PARTICIPANTS:All the day-surgery patients admitted to the Centre for Day Surgery in December 2011. MAIN OUTCOME MEASURES:Demographic profiles, each patient's value and risk perceptions about day surgery, as well as overall satisfaction with day surgery. RESULTS:Convenience value and social value were emphasised by 87% and 60% of the 153 valid respondents, respectively. Comparatively speaking, functional and economic value were respectively chosen by 50% and 43% of the respondents, while 75% worried about postoperative complications and adverse events, only 53% and 27% worried about rehabilitation knowledge and psychological risks, respectively. More than 95% of the respondents were satisfied with the clinic service and staff attitudes, hospital surgery environment, operating skills and results, but fewer (84%) were satisfied with the communication processes surrounding day surgery. CONCLUSION:Patients exhibited high acceptance and satisfaction regarding day surgery. The convenience experienced by patients and their families is the main perceived value of day surgery. Nevertheless, during the recovery process patients are concerned about possible adverse events, treatment of postoperative complications, and lack of information. These aspects of care delivery warrant improvement through redesign of the day surgery service.
10.12809/hkmj133966
Day-surgery in otology: Impact study of a dedicated organizational model.
Lazard D S,Donné F,Lecanu J B
European annals of otorhinolaryngology, head and neck diseases
AIM:Day surgery (DS) in otology in France is insufficiently implemented compared to other countries of comparable socio-economic level. The aim of the present study was to evaluate changes in surgical practice in "major otology" cases in a hospital center after launching a dedicated ENT DS unit. MATERIAL AND METHODS:This new unit, designed in collaboration with the surgeons, was inaugurated in 2014. Number of procedures, patient demographics, surgery durations, and rates of crossover from DS to conventional management were recorded prospectively for the year before and the year after the launch. All otologic surgery procedures with at least tympanomeatal flap elevation were included; minor surgeries such as grommet insertion were excluded. RESULTS:Between the two time periods, major otology day cases increased from 106 to 153 procedures (+43%). In 2013, the DS rate was 27%, versus 56% in 2015. Otosclerosis surgeries represented 7% in 2013 and 15% in 2015, and type II and III tympanoplasties 3% and 24% respectively. Difference in patient age between DS and conventional surgery was lower in 2015. Crossover rates were 10% in 2013 and 21% in 2015, mainly due to nausea/vertigo (56%) and surgery ending too late in the day (33%). CONCLUSION:Major otologic cases are suitable for DS. Launching this dedicated unit with its specific organization enabled a very significant increase in DS rates, probably due to greater patient satisfaction and surgeons' growing confidence. The main pitfall was in scheduling, with surgery ending too late in the day for discharge home; this has since been corrected.
10.1016/j.anorl.2019.09.006
[Day-surgery as a factor in reducing hospital stay].
Sturniolo Giovanni,Bonanno Loretta,Lo Schiavo Maria Grazia,Tonante Agata,Taranto Filippo,Gagliano Ettore,Sturniolo Giacomo
Chirurgia italiana
The authors analyse the factors that have conditioned the early development of day-surgery in Italy and enumerate its fields of application. They outline the history of day-surgery and report the results of studies, citing laws, documents, rules and guidelines governing its application in Italy today. They also analyse the reasons why a more widespread use of day-surgery is proving difficult in Italy. They consider the surgeon's liability and briefly report the results of day-surgery activity at the "G. Martino" Polyclinic Endocrine General Surgery Unit in Messina, consisting in over 3000 operations since 1987. In conclusion, they consider the undoubted advantages of day-surgery for selected operations and stress that it is an effective alternative in comparison with the traditional hospital stay, according to the new philosophy inspiring modern medical care, namely, that of "operating better, in the patient's interest, at lower cost, and quickly".
Minilaparotomy cholecystectomy as a day surgery procedure: a prospective clinical pilot study.
Harju J,Pääkkönen M,Eskelinen M
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society
BACKGROUND AND AIMS:In some studies minilaparotomy cholecystectomy (MC) has been shown to be as good as laparoscopic cholecystectomy (LC) in the surgical treatment of cholecystolithiasis. To our knowledge, the MC operation is rarely considered as a day surgery procedure. PATIENTS AND METHODS:Thirty elective symptomatic non-complicated patients were included in the study during the end of the year 2004 to June 2005. The mean age of patients was 52 years (range 27-68), the mean body mass index 29 kg/m2 (range 19-41). Gallstones were confirmed with ultrasound and the preoperative liver laboratory tests were normal in all patients. A five (+/-2) centimetre-long incision was used avoiding to split the rectus abdominis muscle. All patients were re-evaluated four weeks postoperatively with the follow-up letter. RESULTS:The average operating time was 51 minutes (range 30-105 minutes). Day surgery was possible in 25 cases (83%). Five patients (17%) stayed over night at the hospital. There were four (13%) conversions to conventional cholecystectomy. The average postoperative sick leave was 16 days (range 14-30). Two patients returned to hospital. One patient had wound pain, but no complication was found, and the patient was not admitted. One patient had a wound infection and spent 6 days in the hospital. Twenty-nine (97%) patients were satisfied with the operation and were ready to recommend it for other patients. CONCLUSIONS:The results of this study support the suitability of MC as a day surgery procedure, but a prospective randomised trial is needed to evaluate the relative advantages of MC and LC.
10.1177/145749690709600304
Twenty-five years of ambulatory laparoscopic cholecystectomy.
Bueno Lledó José,Granero Castro Pablo,Gomez I Gavara Inmaculada,Ibañez Cirión Jose L,López Andújar Rafael,García Granero Eduardo
Cirugia espanola
It is accepted by the surgical community that laparoscopic cholecystectomy (LC) is the technique of choice in the treatment of symptomatic cholelithiasis. However, more controversial is the standardization of system implementation in Ambulatory Surgery because of its different different connotations. This article aims to update the factors that influence the performance of LC in day surgery, analyzing the 25 years since its implementation, focusing on the quality and acceptance by the patient. Individualization is essential: patient selection criteria and the implementation by experienced teams in LC, are factors that ensure high guarantee of success.
10.1016/j.ciresp.2015.03.012
Evaluate the outcome and identify predictive failure of outpatient laparoscopic cholecystectomy.
Hosseini Seyed Nejat,Mousavinasab Seyed Nouraddin,Rahmanpour Haleh
JPMA. The Journal of the Pakistan Medical Association
OBJECTIVE:To evaluate the outcome of undertaking out-patient laparoscopic cholecystectomy (OLC) and identifying its predictive failures. METHODS:One hundred and forty-nine consecutive patients with symptomatic cholelithiasis scheduled for preplanned elective laparoscopic cholecystectomy (LC) from August 2004 to December 2006 were included in the study. Patients with associated severe diseases, ASA class III and IV who would have required post operative surgical care, residents of remote areas and other surgical reasoning were entered in Inpatient's Laparoscopic Cholecystectomy (ILC) group (n = 57) and others were enrolled in OLC group (n = 87). Five patients converted to open surgery and thus were excluded from the study. All patients were recruited during the initial outpatient visit and the full preoperative details were explained to them. All of the related factors of OLC were recorded in every visit. Significant differences were evaluated using Chi-square and fisher exact test. RESULTS:Eighty seven patients (58.3%) were selected for outpatient group from which 69 patients (79.3%) successfully underwent outpatient LC. Eighteen (20.7%) patients (failure rate) were not discharged at all. Comparing successful and unsuccessful OLC, the mean age was 41.1 +/- 12.7 vs 51.3 +/- 16.1 years (P = 0.005), also the mean operation time was 33.7 +/- 13.3 vs 33.1 +/- 13.8 minutes and the ability for oral intake existed in 66 patients (95.7%) vs 15 patients (83.3%) (P = 0.1) respectively. Pain was the most common cause of failure of OLC. CONCLUSIONS:OLC is safe and feasible with low readmission. It achieves high levels of patient satisfaction and acceptance, when patients are carefully selected. A prospective study with a larger sample size should be warranted to verify whether OLC can be useful for high age and high ASA class patients.
Laparoscopic cholecystectomy in day surgery: feasibility and outcomes of the first 400 patients.
Brescia Antonio,Gasparrini Marcello,Nigri Giuseppe,Cosenza Umile Michele,Dall'Oglio Anna,Pancaldi Alessandra,Vitale Valeria,Mari Francesco Saverio
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
BACKGROUND:The aim of this study was to evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in a day surgery setting in Italy. MATERIAL AND METHODS:Between March 2003 and June 2011, in our institution 439 patients were selected for day surgery LC. To evaluate the efficacy and safety of the procedure, postoperative complications, pain, nausea and vomiting were monitored at 4, 8, and 24 h after surgery. Patients admitted for an overnight stay or readmitted after discharging were also monitored. RESULTS:Over 8 years we performed 400 LC in day surgery setting and no conversion or major intraoperative complication were detected. A total of 387 patients (96.7%) were successfully discharged after 8-10 h of observation. Postoperative monitoring showed good pain control (mean VAS score 1.5) and only 3 (0.7%) of the 7 patients who experienced major pain were admitted. Twenty-seven patients (6.7%) experienced PONV and 9 (2.2%) of these required admission. None of the patients needed to be readmitted after discharging. The satisfaction questionnaire administered at 1 month office visit showed that 380 patients (95%) were satisfied with day surgery LC. CONCLUSIONS:Our success rate of 96.7% can be attributed to strict adherence to the patient selection criteria. The main reasons for hospital admission were pain and PONV; adequate control of these represents the key of success for day surgery LC. This study confirms the feasibility and safety of LC performed in day surgery setting.
10.1016/j.surge.2012.09.006
AMBULATORY LAPAROSCOPIC CHOLECYSTECTOMY IS SAFE AND COST-EFFECTIVE: a Brazilian single center experience.
Teixeira Uirá Fernandes,Goldoni Marcos Bertozzi,Machry Mayara Christ,Ceccon Pedro Ney,Fontes Paulo Roberto Ott,Waechter Fábio Luiz
Arquivos de gastroenterologia
BACKGROUND:- Laparoscopic cholecystectomy is the treatment of choice for gallstone disease, and has been perfomed as an outpatient surgery in many Institutions over the last few years. OBJECTIVE:- This is a retrospective study of a single center in Brazil, that aims to analyze the outcomes of 200 cases of ambulatory laparoscopic cholecystectomy performed by the same Hepato-Pancreato-Biliary team, evaluating the safety and cost-effectiveness of the method. METHODS:- Two hundred consecutive patients who underwent elective laparoscopic cholecystectomy were retrospectively analyzed; some of them underwent additional procedures, as liver biopsies and abdominal hernias repair. RESULTS:- From a total of 200 cases, the outpatient surgery protocol could not be carried out in 22 (11%). Twenty one (95.5%) patients remained hospitalized for 1 day and 1 (4.5%) patient remained hospitalized for 2 days. From the 178 patients who underwent ambulatory laparoscopic cholecystectomy, 3 (1.7 %) patients returned to the emergency room before the review appointment. Hospital cost was on average 35% lower for the ambulatory group. CONCLUSION:- With appropriate selection criteria, ambulatory laparoscopic cholecystectomy is feasible, safe and effective; readmission rate is low, as well as complications related to the method. Cost savings and patient satisfaction support its adoption. Other studies are necessary to recommend this procedure as standard practice in Brazil.
10.1590/S0004-28032016000200010
Feasibility and safety of day-surgery laparoscopic cholecystectomy: a single-institution 5-year experience of 1140 cases.
Al-Omani Saud,Almodhaiberi Helayel,Ali Bander,Alballa Abdulrahman,Alsowaina Khalid,Alhasan Ibrahim,Algarni Abdullah,Alharbi Haifa,Degna ,Alarma Maria-Rosene
Korean journal of hepato-biliary-pancreatic surgery
BACKGROUNDS/AIMS:We report our experience with day-surgery laparoscopic cholecystectomy and assess its feasibility and safety. METHODS:Data was collected on all the patients who underwent day-surgery laparoscopic cholecystectomy between February 2009 and February 2014 at Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. All patients had symptomatic cholelithiasis that was proven on imaging studies with clearance of the common bile duct. The patient biographical data (age, gender, American Society of Anaesthesiology status, medical comorbidities) and surgical outcomes were then obtained. There was an evaluation of the success rate of day-surgery laparoscopic cholecystectomy, reasons for unexpected admission, and the re-admission rate. RESULTS:A total of 1,140 patients were included in this study. The success rate for day-surgery laparoscopic cholecystectomy was 96%. The reasons for unexpected hospital admission for 46 patients (4%) included persistent abdominal pain and postoperative emesis. The postoperative re-admission rate was 0.4% (5 patients). There were no major complications, and the conversion rate was 0.5% (6 patients). CONCLUSIONS:We suggest that day-surgery laparoscopic cholecystectomy is both safe and feasible in a local setting. Careful patient selection is essential in ensuring a high success rate.
10.14701/kjhbps.2015.19.3.109
Outpatient cholecystectomy at hospitals versus freestanding ambulatory surgical centers.
Paquette Ian M,Smink Douglas,Finlayson Samuel R G
Journal of the American College of Surgeons
BACKGROUND:Because of safety concerns, some payers do not reimburse for laparoscopic cholecystectomy performed in freestanding ambulatory surgical centers (ASCs). This policy has been controversial because of increasing competition between ASCs and hospitals for low risk surgical patients. STUDY DESIGN:We performed a retrospective cohort study of patients undergoing elective outpatient laparoscopic cholecystectomy in the state of Florida in 2002 and 2003 (n=40,040), using the Agency for Healthcare Research and Quality State Ambulatory Surgery Database. Patients treated in hospitals and ASCs were compared with respect to patient characteristics, charges, outcomes, and processes of care. RESULTS:For both hospital-based and ASC-based laparoscopic cholecystectomy patients, greater than 99% were successfully discharged home, and there were no reported deaths. Compared with those treated in hospitals, patients in ASCs had a higher rate of intraoperative cholangiogram (39% versus 36%, p=0.008). There was no difference in the proportion of procedures converted to open cholecystectomy. ASC-based patients were slightly younger (mean age 45 years versus 49 years, p < 0.001), were less often diagnosed with acute cholecystitis (4.8% versus 8.3%, p < 0.001), and had fewer comorbidities on average than hospital-based patients, but both cohorts had few comorbidities overall (99% had Charlson scores of 0 or 1). ASC patients were more likely to be Caucasian (86% versus 75%, p < 0.001) and were more likely to have private insurance (92% versus 67%, p < 0.001). For patients who had ambulatory laparoscopic cholecystectomy as the only procedure, the median charges were $6,028 at ASCs, compared with $10,876 at hospitals. CONCLUSIONS:In a population of slightly younger, healthier patients, laparoscopic cholecystectomy in freestanding ASCs appears to be performed safely and with substantially lower charges than in hospitals.
10.1016/j.jamcollsurg.2007.07.042
Ambulatory laparoscopic cholecystectomy: Systematic review and meta-analysis of predictors of failure.
Balciscueta Izaskun,Barberà Ferran,Lorenzo Javier,Martínez Susana,Sebastián Maria,Balciscueta Zutoia
Surgery
BACKGROUND:Outpatient laparoscopic cholecystectomy has proven to be a safe and cost-effective technique; however, it is not yet a universally widespread procedure. The aim of the study was to determine the predictive factors of outpatient laparoscopic cholecystectomy failure. METHOD:A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis methodology. MEDLINE, Cochrane Library, Ovid, and ISRCTN Registry were searched. The main variables were demographic (age, sex), clinical (weight, American Society of Anesthesiologists classification, previous complicated biliary pathology, history of abdominal surgery in supramesocolic compartment, gallbladder wall thickness), and surgical factors (operative time, afternoon surgery). The secondary variables were the prevalence rates of outpatient laparoscopic cholecystectomy failure due to pain or postoperative nausea and vomiting. RESULTS:Fourteen studies (4,194 patients) were included, with a mean outpatient laparoscopic cholecystectomy failure rate of 23.4%. The predictors of outpatient laparoscopic cholecystectomy failure were: age ≥65 years (odds ratio: 2.34; 95% confidence interval, 1.42-3.86; P = .0009), body mass index ≥30 (odds ratio: 1.6; 95% confidence interval, 1.05-2.45; P = .03), American Society of Anesthesiologists score ≥III (odds ratio: 2.89; 95% confidence interval, 1.72-4.87; P < .0001), previous complicated biliary pathology (odds ratio: 2.39; 95% confidence interval, 1.40-4.06; P = .001), gallbladder wall thickening (odds ratio: 2.33; 95% confidence interval, 1.34-4.04; P = .003), surgical time exceeding 60 minutes (mean difference: -16.03; 95% confidence interval,-21.25 to -10.81; P < .00001), and the beginning of surgery after 1:00 pm (odds ratio: 4.20; 95% confidence interval, 1.97-11.96; P = .007). Sex (odds ratio: 1.07; 95% confidence interval, 0.73-1.57, P = .73) and history of abdominal surgery in the supramesocolic compartment (odds ratio: 2.32; 95 confidence interval, 0.92-5.82, P = .07) were not associated with outpatient laparoscopic cholecystectomy failure. CONCLUSION:Our meta-analysis allowed us to identify the predictors of outpatient laparoscopic cholecystectomy failure. The knowledge of these factors could help surgeons in their decision-making process for the selection of patients who are suitable for outpatient laparoscopic cholecystectomy.
10.1016/j.surg.2020.12.029
An Effective Approach to Improving Day-Case Rates following Laparoscopic Cholecystectomy.
Clarke M G,Wheatley T,Hill M,Werrett G,Sanders G
Minimally invasive surgery
Background. Day-case laparoscopic cholecystectomy (LC) is a safe and cost-effective treatment for gallstones. In 2006, our institution recorded an 86% laparoscopic, 10% day-case, and 5% readmission rate. A gallbladder pathway was therefore introduced in 2007 with the aim of increasing daycase rates. Methods. Patients with symptomatic gallstones, proven on ultrasound, were referred to a specialist-led clinic. Those suitable for surgery were consented, preassessed, and provided with a choice of dates. All defaulted to day case unless deemed unsuitable due to comorbidity or social factors. Results. The number of cholecystectomies increased from 464 in 2006 to 578 in 2008. Day-case rates in 2006, 2007, 2008, and June 2009 were 10%, 20%, 30%, and 61%, respectively. Laparoscopic and readmission rates remained unchanged. Conversion rates for elective cholecystectomy fell from 6% in 2006 to 3% in 2009. Conclusions. Development of a gallbladder pathway increased day-case rates sixfold without an associated increase in conversion or readmission rates.
10.1155/2011/564587
Day versus night laparoscopic cholecystectomy for acute cholecystitis: A comparison of outcomes and cost.
Siada Sammy S,Schaetzel Shaina S,Chen Allen K,Hoang Huy D,Wilder Fatima G,Dirks Rachel C,Kaups Krista L,Davis James W
American journal of surgery
BACKGROUND:Recent studies have suggested higher complication and conversion to open rates for nighttime laparoscopic cholecystectomy (LC) and recommend against the practice. We hypothesize that patients undergoing night LC for acute cholecystitis have decreased hospital length of stay and cost with no difference in complication and conversion rates. METHODS:A retrospective review of patients with acute cholecystitis who underwent LC from October 2011 through June 2015 was performed. Complication rates, length of stay, and cost of hospitalization were compared between patients undergoing day cholecystectomy and night cholecystectomy. RESULTS:Complication rates and costs did not differ between the day and night groups. Length of stay was shorter in the night group (2.4 vs 2.8 days, p = 0.002). CONCLUSIONS:Performing LC for acute cholecystitis during night-time hours does not increase risk of complications and decreases length of stay.
10.1016/j.amjsurg.2017.08.027
Improving the day case rate for laparoscopic cholecystectomy via introduction of a dedicated clinical pathway.
Aslet Med,Yates Dra,Wasawo S
Journal of perioperative practice
Day case laparoscopic cholecystectomy is a safe and economical procedure. However, successful discharge on the same day of the procedure has been difficult to achieve at our institution. This study introduced a standardised anaesthetic pathway aiming to increase same day discharges. This led to an overall increase in same day discharges from 42.0% to 54.1%. When the pathway was fully followed, 71% of patients were discharged on the same day. When the pathway was not followed at all, the same day discharge rate was 0%. Our study successfully demonstrates that small enhancements to perioperative care can accelerate patient recovery and improve same day discharges.
10.1177/1750458919862701
The possibilities of day surgery system development within the health policy in Slovakia.
Health economics review
BACKGROUND:In the day surgery system are intertwined elements of state health policy, health care payers' interests, employers of health care system, as well as the interests and wishes of patients. A problem in the health policy is to find a way to regulate ambulatory and short-term surgical procedures, which are hardly distinguishable, and still fulfil the requirements of transparent financing, quality and security. The objective of this paper is to highlight the reasons for the long-term stagnation in Slovakia day surgery and the possibilities of eliminating the structural drivers causing this negative phenomenon. METHODS:Due to the nature of the analyzed data and desired outcomes, we selected application of correspondence analysis. Results of correspondence analysis provide valuable information necessary for the projection of specialization of one day surgery clinics for that type of procedure, as well as for the support of the new clinics creation (also with the potential state support), the pricing policy, systemic reduction of beds what is connected with reduction of underutilized departments in hospitals, in order to optimize management processes in the healthcare system. RESULTS:Contribution reveals negative aspects which causing a low level of day surgery in Slovakia. Moreover, it reveals the approaches of the different subjects of day surgery. Presented options for setting optimal strategy supporting its development are based on the results of the analysis. Correspondence analysis provided valuable information of present structure of the day surgery system. The determined similarity of the regions and association of specialized fields indicate specific settings of the day surgery system and its components that are inevitable to analyze in the subsequent analytical process. CONCLUSIONS:Results of the analysis are very important in order to set up the system measures in the process of its further development, which should be part of the strategic plan of each health system. On conceptual and methodological issues related with reporting of day surgery performances are highlighting international organizations such as the OECD,WHO. JEL CLASSIFICATION:I13, I18, H51.
10.1186/s13561-014-0035-1
Day case surgery in Nigerian children: influence of social circumstances of patients.
Usang U E,Sowande O A,Ademuyiwa A O,Bakare T I B,Adejuyigbe O
Annals of African medicine
BACKGROUND:In order to achieve good results in day surgery and avoid pitfalls, selection of appropriate procedures and patients is required with attention given to the social circumstances among other considerations. The aim of this prospective study therefore was to evaluate the influence of the social circumstances of the patients on the performance of day surgery practice in our environment. METHOD:This was a prospective study carried out between April, 2004 and December, 2004, during which time 88 children aged 15 years and below with uncomplicated inguinal hernias were treated at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). The parents of the patients were interviewed about their social circumstances to determine the possibility of compliance with postoperative instructions. The data generated were then analyzed. RESULTS:More than half (54.6%) of the patients were from Ile-Ife. A few came from towns varying in distances from 65 to 80 km and spent an average time of 75 to 90 minutes to reach the hospital. Majority of the patients used public vehicles as a means of transport to and from the hospital in escort of their mothers. Despite the long distances and difficult traveling conditions, the parents still preferred day case surgery and were willing to obey postoperative instructions. CONCLUSION:From the findings in this study, day case surgery in children in our environment is feasible, despite the poor social circumstances of most of them. There is, however a compelling need to raise the standard of living of the people to enable them benefit maximally from day case surgery.
10.4103/1596-3519.55763
Exploration of Disparities in Regions and Specialized Fields of Day Surgery System.
Gavurova Beata,Khouri Samer,Korony Samuel
International journal of environmental research and public health
The main objective of this paper was to find similarities among eight Slovak regions from the viewpoint of five specialized day surgery fields and among specialized day surgery fields from the viewpoint of Slovak regions on the basis of day surgery operated and hospitalized patient counts. Day surgery data of paediatric patients and of adult patients from the National Health Information Centre during the years 2009-2017 were used. Correspondence analysis in two dimensions of the Slovak regions and of specialized day surgery fields was applied in order to achieve the paper's objective. The Košice Region differs most from the overall national average in both groups of paediatric day surgery. This is caused by its largest proportions in the fields of Gynaecology (29.7%) and Urology (48.0%) (operated patients), and in the fields of Gynaecology (60.5%) and Surgery (21.6%) (hospitalized patients). The most different specialized day surgery fields from overall average are: Urology (operated paediatric patients), Gynaecology (hospitalized paediatric patients), Otorhinolaryngology (operated adult patients) and Ophthalmology (hospitalized adult patients). Urogenital system day surgery procedures (Gynaecology, Urology) are separated from other three fields (i.e., Surgery, Ophthalmology, Otorhinolaryngology) either in the first or in the second dimension of the singular value matrix decomposition.
10.3390/ijerph17030936
Day care versus in-patient surgery for age-related cataract.
Lawrence David,Fedorowicz Zbys,van Zuuren Esther J
The Cochrane database of systematic reviews
BACKGROUND:Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract living in lower income countries. With the increased number of people with cataract, it is important to review the evidence on the effectiveness of day care cataract surgery. OBJECTIVES:To provide authoritative, reliable evidence regarding the safety, feasibility, effectiveness and cost-effectiveness of day case cataract extraction by comparing clinical outcomes, cost-effectiveness, patient satisfaction or a combination of these in cataract operations performed in day care versus in-patient units. SEARCH METHODS:We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2015), EMBASE (January 1980 to August 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to August 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 17 August 2015. SELECTION CRITERIA:We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation. DATA COLLECTION AND ANALYSIS:Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials. MAIN RESULTS:We included two trials. One study was conducted in the USA in 1981 (250 people randomised and completed trial) and one study conducted in Spain in 2001 (1034 randomised, 935 completed trial). Both trials used extracapsular cataract extraction techniques that are not commonly used in higher income countries now. Most of the data in this review came from the larger trial, which we judged to be at low risk of bias.The mean change in visual acuity (in Snellen lines) of the operated eye four months postoperatively was similar in people given day care surgery (mean 4.1 lines standard deviation (SD) 2.3, 464 participants) compared to people treated as in-patients (mean 4.1 lines, SD 2.2, 471 participants) (P value = 0.74). No data were available from either study on intra-operative complications.Wound leakage, intraocular pressure (IOP) and corneal oedema were reported in the first day postoperatively and at four months after surgery. There was an increased risk of high IOP in the day care group in the first day after surgery (risk ratio (RR) 3.33, 95% confidence intervals (CI) 1.21 to 9.16, 935 participants) but not at four months (RR 0.61, 95% CI 0.14 to 2.55, 935 participants). The findings for the other outcomes were inconclusive with wide CIs. There were two cases of endophthalmitis observed at four months in the day care group and none in the in-patient group. The smaller study stated that there were no infections or severe hyphaemas.In a subset of participants evaluated for quality of life (VF14 questionnaire) similar change in quality of life before and four months after surgery was observed (mean change in VF14 score: day care group 25.2, SD 21.2, 150 participants; in-patient group: 23.5, SD 25.7, 155 participants; P value = 0.30). Subjective assessment of patient satisfaction in the smaller study suggested that participants preferred to recuperate at home, were more comfortable in their familiar surroundings and enjoyed the family support that they received at home. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. AUTHORS' CONCLUSIONS:This review provides evidence that there is cost saving with day care cataract surgery compared to in-patient cataract surgery. Although effects on visual acuity and quality of life appeared similar, the evidence with respect to postoperative complications was inconclusive because the effect estimates were imprecise. Given the wide-spread adoption of day care cataract surgery, future research in cataract clinical pathways should focus on evidence provided by high quality clinical databases (registers), which would enable clinicians and healthcare planners to agree clinical and social indications for in-patient care and so make better use of resources.
10.1002/14651858.CD004242.pub5
Day-surgery versus overnight stay surgery for laparoscopic cholecystectomy.
Vaughan Jessica,Gurusamy Kurinchi Selvan,Davidson Brian R
The Cochrane database of systematic reviews
BACKGROUND:Laparoscopic cholecystectomy is used to manage symptomatic gallstones. There is considerable controversy regarding whether it should be done as day-surgery or as an overnight stay surgery with regards to patient safety. OBJECTIVES:To assess the impact of day-surgery versus overnight stay laparoscopic cholecystectomy on patient-oriented outcomes such as mortality, severe adverse events, and quality of life. SEARCH METHODS:We searched the Cochrane Hepato-Biliary Group Controlled Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and mRCT until September 2012. SELECTION CRITERIA:We included randomised clinical trials comparing day-surgery versus overnight stay surgery for laparoscopic cholecystectomy, irrespective of language or publication status. DATA COLLECTION AND ANALYSIS:Two authors independently assessed trials for inclusion and independently extracted the data. We analysed the data with both the fixed-effect and the random-effects models using Review Manager 5 analysis. We calculated the risk ratio (RR), mean difference (MD), or standardised mean difference (SMD) with 95% confidence intervals (CI) based on intention-to-treat or available case analysis. MAIN RESULTS:We identified a total of six trials at high risk of bias involving 492 participants undergoing day-case laparoscopic cholecystectomy (n = 239) versus overnight stay laparoscopic cholecystectomy (n = 253) for symptomatic gallstones. The number of participants in each trial ranged from 28 to 150. The proportion of women in the trials varied between 74% and 84%. The mean or median age in the trials varied between 40 and 47 years.With regards to primary outcomes, only one trial reported short-term mortality. However, the trial stated that there were no deaths in either of the groups. We inferred from the other outcomes that there was no short-term mortality in the remaining trials. Long-term mortality was not reported in any of the trials. There was no significant difference in the rate of serious adverse events between the two groups (4 trials; 391 participants; 7/191 (weighted rate 1.6%) in the day-surgery group versus 1/200 (0.5%) in the overnight stay surgery group; rate ratio 3.24; 95% CI 0.74 to 14.09). There was no significant difference in quality of life between the two groups (4 trials; 333 participants; SMD -0.11; 95% CI -0.33 to 0.10).There was no significant difference between the two groups regarding the secondary outcomes of our review: pain (3 trials; 175 participants; MD 0.02 cm visual analogue scale score; 95% CI -0.69 to 0.73); time to return to activity (2 trials, 217 participants; MD -0.55 days; 95% CI -2.18 to 1.08); and return to work (1 trial, 74 participants; MD -2.00 days; 95% CI -10.34 to 6.34). No significant difference was seen in hospital readmission rate (5 trials; 464 participants; 6/225 (weighted rate 0.5%) in the day-surgery group versus 5/239 (2.1%) in the overnight stay surgery group (rate ratio 1.25; 95% CI 0.43 to 3.63) or in the proportion of people requiring hospital readmissions (3 trials; 290 participants; 5/136 (weighted proportion 3.5%) in the day-surgery group versus 5/154 (3.2%) in the overnight stay surgery group; RR 1.09; 95% CI 0.33 to 3.60). No significant difference was seen in the proportion of failed discharge (failure to be discharged as planned) between the two groups (5 trials; 419 participants; 42/205 (weighted proportion 19.3%) in the day-surgery group versus 43/214 (20.1%) in the overnight stay surgery group; RR 0.96; 95% CI 0.65 to 1.41). For all outcomes except pain, the accrued information was far less than the diversity-adjusted required information size to exclude random errors. AUTHORS' CONCLUSIONS:Day-surgery appears just as safe as overnight stay surgery in laparoscopic cholecystectomy. Day-surgery does not seem to result in improvement in any patient-oriented outcomes such as return to normal activity or earlier return to work. The randomised clinical trials backing these statements are weakened by risks of systematic errors (bias) and risks of random errors (play of chance). More randomised clinical trials are needed to assess the impact of day-surgery laparoscopic cholecystectomy on the quality of life as well as other outcomes of patients.
10.1002/14651858.CD006798.pub4
Postoperative pain assessment tools in day surgery: literature review.
Coll Anne Marie,Ameen Jamal R M,Mead Donna
Journal of advanced nursing
BACKGROUND:Postoperative pain is an expected phenomenon. However, its passage beyond acceptable limits is a common and costly experience. This is particularly the case in day surgery, partly because of the increasing demand to reduce waiting lists for elective surgery, and partly because of lack of knowledge about patients' experiences of postoperative pain and relevant published research. The latter is mainly concerned with different interpretations of the phenomenon of pain that appear to have led to a variety of often inappropriate pain measurement tools. AIM:This paper critically reviews some of the available objective and subjective measures of pain and establishes the suitability of a Visual Analogue Scale (VAS) for measuring the intensity of pain after day surgery. METHOD:Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, day surgery, ambulatory surgery, rating scales, VAS, severity, assessment, tool, nursing, validity, sensitivity, reliability and their various combinations. The databases used were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search included only papers published in the English language. FINDINGS:A range of interpretations of pain have led to the development of various measurement tools that address different components of pain. This inconsistency has led to ineffective pain management. Based on established criteria, the VAS was found to be methodologically sound, conceptually simple, easy to administer and unobtrusive to the respondent. On these grounds, the VAS seems to be most suitable for measuring intensity of pain after day surgery. CONCLUSIONS:Common guidelines on the definition and measurement of pain are needed. In day surgery, the availability of a unified and reliable measure of pain that can address its sensory component, such as the VAS, will provide more reliable information about the pain experience and, hence, improve its overall management.
10.1111/j.1365-2648.2003.02972.x
Pain management in day-case surgery.
Mitchell Mark
Nursing standard (Royal College of Nursing (Great Britain) : 1987)
BACKGROUND:Effective pain management following day surgery is a challenging issue. For the majority of patients severe pain is uncommon. However, a number of patients experience considerable pain following discharge. Uncontrolled pain is one of the main causes of re-admission to an inpatient bed following day surgery and a leading cause of patient dissatisfaction with it. CONCLUSION:This article reviews the literature and there is a discussion of the issues concerning effective pain management in day surgery. The drugs commonly used in day surgery practice are outlined to demonstrate the constraints that day surgery practices can impose on effective pain management. Day surgery is continually expanding and hip replacement and cholecystectomy are now being undertaken in day surgery facilities (Amarnath et al 2002, Berger 2003). The role of the nurse in effective pain management is therefore crucial amid such innovative developments as, even when explicitly instructed, the majority of patients still experience some post-operative pain.
10.7748/ns2004.03.18.25.33.c3559
Day surgery, including the preoperative assessment of the patient: a UK experience by a Belgian anaesthetist.
Cammu G,Smith I
Acta anaesthesiologica Belgica
In some European countries like Belgium, a lot of hospitals are today dealing with two extremely real issues: adult day surgery and the preoperative anaesthesia consultation. Although efforts are made, there is often still a search for a clear-cut identity on these subjects. As in the rest of Europe, Belgian political, financial and medical driving forces are strongly favouring the shift of surgical procedures towards more day care practice. However, our country has not already reached the level of the United Kingdom, Canada, Australia, or the USA, where the greater majority of all surgery is ambulatory surgery. The development of new surgical technology, however, favours minimal invasiveness, whereas 'newer' anaesthetic agents result in fast recovery. In setting up real surgical day care facilities, Belgian medical and nursing staff, together with the hospital management, will have to cope with the worldwide existing variation in performing ambulatory surgery, at a hospital level, at a surgeon's and anaesthetist's level and at a provision level. Careful patient selection, conscientious anaesthetic management, and being attentive to caring for a patient leaving the hospital, are the cornerstones of decent ambulatory anaesthesia and surgery, and the key for long-term success. Together with dedicated facilities, it is therefore mandatory to have competent and enthusiastic staff. The nursing director, as well as the medical director of the day unit will have to use their power in order to avoid abuse of ambulatory beds for other purposes. As the perioperative specialist, the anaesthetist is ideally suited for the pre-, per-, and postoperative management of the ambulatory patient. Moreover, concerning the preoperative assessment clinic, UK anaesthetists have organized a valuable and interesting alternative to the expensive and time/manpower consuming system used in the USA.
A UK experience of daycase cochlear implant surgery.
Mawby T A R,Kaleva A I,Ramsden J D
Cochlear implants international
OBJECTIVES:This study aims to assess the safety of daycase cochlear implant surgery. METHODS:A retrospective review was conducted on all patients who underwent cochlear implant surgery at a teaching hospital in Oxford, UK between September 2008 and February 2012. RESULTS:One hundred and sixteen patients underwent cochlear implant surgery. This included 73 adults and 43 children. Twenty-six patients underwent the procedure as a daycase procedure. There were no readmissions. DISCUSSION:The demand 'to do more with less' has led to increasing drives for efficiency and cost-effectiveness. Therefore, the role of daycase surgery is becoming increasingly widespread. Daycase surgery has been shown to be advantageous for both patients and hospitals. CONCLUSION:Daycase cochlear implant surgery is feasible and can be safely conducted in a select group of patients.
10.1179/1754762813Y.0000000056
Day surgery unit thoracic surgery: the first UK experience.
Ghosh-Dastidar Michael B,Deshpande Ranjit P,Rajagopal Kailasam,Andersen Deborah,Marrinan Michael T
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
OBJECTIVE:Operating in a day surgery unit has potential benefits, including lower risk of cancellation, reduced infection rates, cost effectiveness and increased patient satisfaction. We believe that we are the first unit in the UK to regularly perform thoracic surgery in a dedicated day surgery unit, and describe our experience to date. METHODS:Data were collected prospectively from 1 September 2007 to 31 December 2009. Following surgery, patients were observed in a recovery area for 1h before transfer back to a short-stay ward. When chest drains were used, they were attached to an ambulatory drainage device for the patient to be discharged with. All patients were reviewed postoperatively, and were discharged home within 4-6h if appropriate. RESULTS:Ninety-eight patients underwent thoracic surgery in our day surgery unit. Sixty (61.2%) patients were male. The mean age was 53.0 (17-83) years. There were no deaths. Twenty-nine (29.6%) were mediastinal procedures (MED group) such as mediastinoscopy/otomy, 31 (31.6%) were video-assisted thoracoscopic surgery (VATS group) procedures such as lung biopsies and pleurodeses and 38 (38.8%) were a variety of other (OTHER group) procedures such as chest wall interventions and sternal wire removal. Out of the cohort, three (3.1%) patients required admission directly from the day surgery unit, and three (3.1%) were admitted late after discharge with problems relating to their surgery. Our Day Surgery Programme accounted for 12.0% of the total thoracic workload during the time period. CONCLUSIONS:Surgeons are continually trying to fast track increasingly complex procedures and, with good patient selection, thoracic surgery can be performed safely and effectively in day surgery units.
10.1016/j.ejcts.2010.09.032
Benchmarking outcomes for day surgery.
Best practice & research. Clinical anaesthesiology
In comparison to large acute care centers, Ambulatory Surgery Centers (ASCs) provide patient-centered, fast, efficient, effective, high-value, high-quality, reliable, and safe care. For these reasons, ASCs are often preferred working venues for perioperative staff and desirable partners for surgeons, proceduralists, and anesthesiologists. Given today's many headwinds, including inflation, downward rate pressures, increasing regulation, and near constant supply chain issues, not to mention increasing patient and procedural complexity, exemplary clinical and operational management is of paramount importance and requires frequent measurement and benchmarking. Benchmarking is critical to performance assessment and is vital for assessing existing processes and new pathways and protocols, and remains the best way to identify areas for improvement. This chapter provides the reader with an overview of key ASC-related performance indicators, what they mean, and how best to measure and compare them to local, regional, and national benchmarks.
10.1016/j.bpa.2023.03.001