scholarly journals ‘True Day Case’ Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
A. Solodkyy ◽  
A. R. Hakeem ◽  
N. Oswald ◽  
F. Di Franco ◽  
S. Gergely ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Preoperative Assessment ◽  
High Volume ◽  
District General Hospital ◽  
Day Case ◽  
Day Case Surgery ◽  
Overnight Stay ◽  
Same Day Discharge ◽  
Case Surgery ◽  
Overnight Stays

Introduction. Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. British Association of Day Case Surgery recommends at least 60% of LCs be performed as day cases. The aim of this study was to assess our rate of true day case LCs and review factors preventing same-day discharge. Methods. We prospectively collected data of all elective LCs performed in a district general hospital over 32 months. Results. 500 patients underwent LC during this period; 438 (88.2%) patients were planned day cases and 59 patients (11.8%) planned overnight stays. Of the planned day cases, 75.8% (n=332) were discharged on the same day and 106 (24.2%) had unexpected overnight stay (UOS). Most patients with BMI >35 and ASA3 planned day case patients were successfully discharged. Drain insertion, longer operations, and late recovery departure were the main reasons for UOS. There were more complications in this group compared to day cases. Conclusions. This unit has a high ‘true day case’ rate of 75.8%. High BMI and ASA3 should not be absolute contraindications to day case surgery. The majority of unexpected overnight stays are unavoidable but may be reduced by patient selection, stringent preoperative assessment, operation scheduling, and reduction in unnecessary drain insertion.

scholarly journals 872 Audit - Unexpected Overnight Stay After Day-Case Surgery In ENT

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Darwich ◽  
M Dawoud ◽  
A Poulios
Keyword(s):  
Day Case ◽  
Day Case Surgery ◽  
Overnight Stay ◽  
Operative Complications ◽  
Case Surgery ◽  
Selection For ◽  
One Year ◽  
Operation Timing ◽  
Overnight Stays ◽  
Theatre List

Abstract Introduction The aim of this audit was to determine the compliance with guidelines regarding patient selection for day-case surgeries in ENT. Method Data was collected retrospectively and included all patients who underwent elective ENT surgeries over a one-year period at an NHS hospital. Factors considered included nature of the operation, timing, surgeon’s preference, as well as social circumstances. Results Out of 1101 intended day cases, 113 (10%) had an unexpected overnight stay. The major factor contributing to these overnight stays was the timing of the operation, where 85 cases had undergone surgery in the afternoon. Other factors included drain siting, saturation monitoring, post-operative complications, and social circumstances. Tonsillectomy-related and nasal procedures formed the majority of the procedures, with 74 cases in total. Conclusions We concluded that most overnight stay cases included in this audit could have been prevented. Careful theatre list planning by prioritizing day cases for morning lists may reduce these numbers significantly. Co-morbidities and social aspects may need to be explored when booking patients for theatres.

Risk-based targeting of adjuvant pregabalin treatment in laparoscopic cholecystectomy: a randomized, controlled trial

2019 ◽  
Vol 19 (2) ◽  
pp. 309-317 ◽  
Author(s):  
Hanna von Plato ◽  
Kristiina Mattila ◽  
Satu Poikola ◽  
Eliisa Löyttyniemi ◽  
Katri Hamunen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Positive Association ◽  
Day Case ◽  
Day Case Surgery ◽  
Multiple Risk Factors ◽  
Item Questionnaire ◽  
Case Surgery ◽  
Multiple Risk

Abstract Background and aims Pain is the most common reason for delayed discharge after day-case laparoscopic cholecystectomy. This study investigates a simple five-item questionnaire in evaluating the risk of postoperative pain in day-case cholecystectomy and the efficacy and safety of single-dose preoperative pregabalin on patients with multiple risk factors for pain. There are no previous studies on targeting adjuvant pain treatment based on the individual risk factors like the preoperative state of anxiety, acute or chronic pain, and the expectation of pain in day-case surgery. Methods One hundred and thirty patients scheduled for day-case laparoscopic cholecystectomy were evaluated with a five-item questionnaire assessing the risk for postoperative pain. The patients with multiple risk factors (n=60) were randomized to receive either pregabalin 150 mg or placebo, 1 h before surgery. The primary outcome was abdominal pain intensity on numerical rating scale (NRS) 1 h after surgery. Pain, analgesic consumption and adverse effects during first three postoperative days, and the length of hospital stay were also recorded. Results Pregabalin 150 mg given as an adjuvant analgesic preoperatively did not decrease postoperative abdominal pain or opioid consumption in the first hour after surgery compared to placebo in a preselected group of patients with multiple risk factors for postoperative pain (p=0.31). Preoperative anxiety assessed with a scale of 0–10 had a positive association with postoperative pain (p=0.045). Conclusions and implications This was the first trial on systematically selecting patients with a high-risk factor profile for postoperative pain as a target for a preventive adjuvant analgesic intervention. Although numerous previous studies have identified various risk factors, including those used in the current trial, it seems to be challenging to use these risk factors as predictive tools for targeting adjuvant analgesics in day-case surgery. Preoperative anxiety has a positive association with postoperative pain in day-case laparoscopic cholecystectomy, and this should be taken into account when treating these patients.

scholarly journals Eras reduces unplanned overnight stay following orthopaedic day case surgery

2014 ◽  
Vol 12 ◽  
pp. S58 ◽  
Author(s):  
Anwen Williams ◽  
Andrew Miller ◽  
Awen Iorwerth ◽  
David Morgan
Keyword(s):  
Day Case ◽  
Day Case Surgery ◽  
Overnight Stay ◽  
Case Surgery

scholarly journals Day case laparoscopic cholecystectomy in patients with high BMI: Experience from a UK centre

2016 ◽  
Vol 98 (5) ◽  
pp. 329-333 ◽  
Author(s):  
A Tandon ◽  
G Sunderland ◽  
QM Nunes ◽  
N Misra ◽  
M Shrotri
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Morbidly Obese ◽  
Day Case ◽  
Potential Cost ◽  
Day Case Surgery ◽  
Gall Stones ◽  
Increased Risk ◽  
Case Surgery ◽  
High Bmi

IntroductionSymptomatic gall stones may require laparoscopic cholecystectomy (LC), which is one of the most commonly performed general surgical operations in the western world. Patients with a high body mass index (BMI) are at increased risk of having gall stones, and are often considered at high risk of surgical complications due to their increased BMI. We believe that day case surgery could nevertheless have significant benefits in terms of potential cost savings and patient satisfaction in this population. We therefore compared the outcomes of day case patients undergoing LC stratified by BMI, with a specific focus on the safety and success of the procedure in obese and morbidly obese groups.MethodsWe reviewed a database of day case procedures performed between January 2004 and December 2012, including all patients with symptomatic gall stone disease who underwent LC. The patients were divided in four BMI groups: less than 25 kg/m2, 25–29 kg/m2, 30–39 kg/m2and 40 kg/m2or above.ResultsThe overall success rate for day case surgery was 78%. There were no significant differences in rates of intra-abdominal collection or readmission with increasing BMI. However, increasing BMI was associated with a significant increase in the rate of wound infection.ConclusionsLC in patients with a high BMI is safe and can be performed effectively as a day case procedure.

scholarly journals General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital

2016 ◽  
Vol 98 (7) ◽  
pp. 479-482 ◽  
Author(s):  
C-S Kwok ◽  
AC Gordon
Keyword(s):  
District General Hospital ◽  
Complication Rates ◽  
Paediatric Surgery ◽  
Day Case ◽  
Day Case Surgery ◽  
Surgical Trainees ◽  
Case Surgery ◽  
The Uk ◽  
Training Opportunities ◽  
Electronic Hospital

Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals.

scholarly journals Age as a Predictive Factor for In-Patient Admission Following Day-Case Shoulder Arthroscopic Sub-Acromial Decompression – A District General Hospital Audit

2008 ◽  
Vol 90 (1) ◽  
pp. 62-64 ◽  
Author(s):  
NPM Jain ◽  
L Ogonda ◽  
NP Trimmings
Keyword(s):  
Postoperative Pain ◽  
Health Service ◽  
Predictive Factor ◽  
Pain Control ◽  
District General Hospital ◽  
Postal Questionnaire ◽  
Patient Admission ◽  
Day Case ◽  
Day Case Surgery ◽  
Case Surgery

INTRODUCTION Admission following day-case surgery can be problematic for both the patient and the health service. The purpose of this study was to identify any factors predictive of admission following arthroscopic sub-acromial decompression (ASAD) of the shoulder planned as day-case procedures. PATIENTS AND METHODS A postal questionnaire provided data for 27 patients undergoing ASAD as a day-case procedure between June 2002 and June 2004. RESULTS Eighteen (66.7%) questionnaires were returned. Of respondents, 38.9% (mean age, 58 years) felt the procedure required in-patient admission due to postoperative pain. These patients had an older mean age than those (61.1%) content with a day-case procedure (mean age, 49 years; P = 0.04). Of patients 55 years and older, 67% felt that the procedure should have an in-patient admission due to postoperative pain compared to 11% of patients under the age of 55 years (P = 0.04). CONCLUSIONS Patient age may be useful as a predictor of the likelihood of postoperative admission for pain control following day-case shoulder surgery and should be taken into account when planning day case lists.

A policy of day-case sinonasal surgery is safe, well tolerated and cost-effective

2021 ◽  
pp. 1-3
Author(s):  
M Duignan ◽  
C Lao ◽  
R Lawrenson ◽  
A J Wood
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Day Case ◽  
Day Case Surgery ◽  
Effectiveness Analysis ◽  
Same Day Discharge ◽  
Case Surgery ◽  
The Cost

Abstract Objective Practices vary regarding the timing of discharge after sinonasal surgery. This study aimed to examine the cost-effectiveness of same-day discharge compared to next-day discharge after sinonasal surgery. Methods A retrospective single-surgeon audit of sinonasal surgery over a 12-month period was performed. Demographic and clinical details, including distance travelled home, timing of discharge, hospital re-presentation, and complications, were collected and compared between the same-day discharge and next-day discharge groups. A cost-effectiveness analysis was performed. Results A total of 181 patients were identified; 117 underwent day-case surgery, of which 6 re-presented to the emergency department. Sixty-four patients stayed overnight after surgery, and six of those patients re-presented to the emergency department. The per patient cost was $3262 for day-case sinonasal surgery and $5050 for those admitted overnight after surgery (p < 0.001). Conclusion Routine same-day discharge after sinonasal surgery is achievable, safe and cost-effective.

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