Day-Case Surgery: A Viable Alternative for Surgical Treatment of Varicose Veins

1987 ◽  
Vol 2 (2) ◽  
pp. 103-108 ◽  
Author(s):  
D.C. Berridge ◽  
G.S. Makin
Keyword(s):  
Patient Group ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Viable Alternative ◽  
Patient Treatment ◽  
Case Group ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
Day Case Surgery ◽  
Case Surgery

One hundred and forty-eight patients (164 limbs) who had varicose vein surgery by the same consultant surgeon 3–10 years previously were reviewed; 61 patients had surgery as an in-patient and 87 as a day-case. The patients were reviewed to assess the efficacy and acceptability of day-case varicose vein surgery. There were no significant differences between the age and sex ratios of the patients. However, twice as many operations in the in-patient group included stripping of the long saphenous vein above the knee (χ2 = 4.2, P = 0.04). Fifteen in-patients had bilateral vein surgery as opposed to only one day-case patient. Fifteen patients suffered complications most of which were minor and were evenly distributed including wound infections (nine), reactionary haemorrhage/haematoma (four), deep vein thrombosis (one) and pulmonary embolus (one). The convalescent period before returning to work was similar in the two groups (U= 953, P= 0.28). The mean duration of stay for the in-patients was 3.9 ± 2.2 days. There was no significant difference in the period off work (day-case: 3.6 ± 2.0 weeks; in-patient: 4 ± 2.9 weeks), or in the length of follow-up (day-case: 6.01 ± 1.24 years; in-patient: 6.79 ± 1.71 years). In the period before review 11 patients in the in-patient group and 13 patients in the day-case group had further surgery or sclerotherapy for recurrent symptomatic varicose veins. At review five patients in the in-patient group and six patients in the day-case group had recurrent sapheno-femoral incompetence (χ2 = 0.1, P = 0.7). A total of 34 patients in both groups had recurrent varicose veins. Only four (4.6%) of the day-case patients expressed a preference for in-patient treatment if they were to have further surgery and 21 (34%) of the in-patient group would prefer day-case surgery. Day-case varicose vein surgery has not been shown to be inferior in terms of complications or recurrence rate. Patient acceptability is good and it is a viable alternative to in-patient treatment in suitable patients in areas with adequate district nurse facilities.

The Influence of Effective Analgesia and General Anaesthesia on Patients' Acceptance of Day Case Varicose Vein Surgery

1993 ◽  
Vol 8 (1) ◽  
pp. 29-31 ◽  
Author(s):  
O. C. Onuma ◽  
P. E. Bearn ◽  
U. Khan ◽  
P. Mallucci ◽  
M. Adiseshiah
Keyword(s):  
General Anaesthesia ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
College Hospital ◽  
Day Case Surgery ◽  
Patient Interview ◽  
Case Surgery ◽  
Analgesia Requirement

Objective: To assess the efficacy of locoregional anaesthesia and non-opiate analgesia in controlling pain after varicose vein surgery. To examine patient attitudes to day case surgery for this condition. Design: Prospective single patient group study (22 consecutive patients). Setting: University College Hospital (Teaching Hospital). Intervention: Locoregional and general anaesthesia. Non-opiate analgesia. Surgical treatment for varicose Main outcome measures: Patient interview, pain scores, analgesia requirement. Result: Post operative Pain was absent in 36% during the first 24 hours. Oral analgesia was given to 36% as inpatients but only 18% after discharge. Before surgery, 95% would have preferred DCS but only 24% at six months. The after-effects of general anaesthesia was the main reason for this change in attitude. Conclusions: Patients would like day case surgery for varicose veins but anaesthesia and analgesia must be satisfactory.

Advances in general surgery 50 years ago

2021 ◽  
pp. 1-2
Author(s):  
Harold Ellis
Keyword(s):  
General Surgery ◽  
Varicose Veins ◽  
Peptic Ulcers ◽  
Day Case ◽  
Day Case Surgery ◽  
Case Surgery ◽  
New Treatments

In 1971, some of the new advances that were set to change the field of general surgery included theories about the development of peptic ulcers, new treatments for varicose veins and pioneering work in the introduction of day case surgery.

Day Case Varicose Vein Surgery: Patient Health Outcome

2001 ◽  
Vol 16 (4) ◽  
pp. 160-163
Author(s):  
K. J. Sweeney ◽  
T. Cheema ◽  
S. O'Keefe ◽  
S. Johnston ◽  
P. Burke ◽  
...  
Keyword(s):  
Physical Function ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Well Being ◽  
Health Perception ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
Population Norms ◽  
Patient Health ◽  
The Impact

Background: The success of day case varicose vein surgery (DCWS) is traditionally denned clinically. However, the patient's perception of his or her own health prior to and following DCWS has not been established. This study prospectively measured the health status of patients with varicose veins, compared this with established population norms and assessed the impact of DCWS on both general health perception and varicose vein symptoms. Method: Fifty-three consecutive patients undergoing DCWS over a 9 month period were enrolled in this study. The SF-36 health assessment questionnaire and a vein-symptom-specific questionnaire were administered on the morning of surgery, 7 weeks postoperatively and 1 year following surgery. All patients in this study underwent a standard varicose vein operation and followed a standard protocol of postoperative management. Results: DCWS population health scores were lower than general population norms preoperatively. There was a significant improvement in the 7 week postoperative group in physical function and health perception (p<0.05). One year after surgery physical function, health perception, mental health and physical role were significantly improved from preoperative scores (p<0.05). Symptom-specific scores demonstrated a sustained trend towards improvement over the postoperative year. Conclusion: Varicose veins are associated with diminished well-being. Day case varicose vein surgery improves patient health perception and symptoms and is the treatment of choice for suitable patients with varicose veins.

The early morbidity of varicose vein surgery

1995 ◽  
Vol 81 (1) ◽  
pp. 42-46
Author(s):  
D C Mackay ◽  
D J Summerton ◽  
A J Walker
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Population Group ◽  
Postal Questionnaire ◽  
Varicose Vein Surgery ◽  
Long Saphenous Vein ◽  
Case Surgery ◽  
Post Operation ◽  
The Difference ◽  
Considerable Morbidity

AbstractThe early outcome and morbidity associated with varicose vein surgery were assessed at six months post operation by postal questionnaire. Most cases underwent sapheno-femoral ligation, above-knee stripping of the long saphenous vein and multiple stab avul sions. A 73.8% response rate resulted in 155 replies, and revealed a high incidence (65.8%) of perceived complications within the first two weeks after surgery. The commonest of these were bruising, pain and numbness. Over a third of patients consulted their general practitioner (GP) postoperatively. Half of these required further management or treatment and the rest, reassurance alone. At six months 79.4 % were satisfied with the outcome of their surgery, although some still claimed problems with residual veins, skin discoloration, numbness, and ankle or foot disco loration. Eleven percent were referred to hospital for further opinion, mostly because of perceived residual varicose veins. The difference between residual and recurrent varicose veins is discussed. No patient fe lt that the standard 2.5 day admission was too long, and 12.9% thought it too short. Day case surgery is not a popular option in this population group.Despite high satisfaction rates, there is a considerable morbidity attached to varicose vein surgery. We believe that good pre- and perioperative communication, augmented by a comprehensive information sheet, is important to prepare patients for those postoperative problems and thus reduces their perceived importance.

The Cost of Day-Case Surgery for Varicose Veins

1991 ◽  
Vol 6 (4) ◽  
pp. 223-225 ◽  
Author(s):  
A. Price ◽  
G. S. Makin
Keyword(s):  
Varicose Veins ◽  
University Hospital ◽  
Day Case ◽  
Day Case Surgery ◽  
Case Surgery ◽  
The Cost

A methodology is described to calculate the cost of day-case surgery at University Hospital, Nottingham during 1988/89, which may be suitable for use elsewhere. Day-case surgery for varicose veins is cheaper than the corresponding inpatient surgery.

Day-case surgery is possible in the majority of men undergoing transurethral resection of the prostate – a report on over 1000 cases

2018 ◽  
Vol 11 (6) ◽  
pp. 403-408
Author(s):  
L Lavan ◽  
G Kyriazis ◽  
D Mbiabjeu ◽  
R Gormley ◽  
S Hall ◽  
...  
Keyword(s):  
Transurethral Resection ◽  
Inpatient Admission ◽  
Case Group ◽  
Day Case ◽  
Readmission Rates ◽  
Level Of Evidence ◽  
Day Case Surgery ◽  
Admission Rates ◽  
Case Surgery ◽  
Based Medicine

Objective: We describe our experience of performing bipolar transurethral resection in saline (Olympus Medical) as a day-case procedure over an initial five-year period. Patients and methods: All procedures coded as transurethral resection of the prostate over a 60-month period were analysed to determine whether the procedure was planned as a day-case or as an inpatient admission, and whether post-operative discharge proceeded as intended. Re-admission rates, reasons for re-admission and transfusion rates were also recorded. Results: Of the 1035 operations, 689 (66.57%) were planned as a day-case procedure (mean age 70.5 years) with 176 (25.5%) requiring inpatient admission, and 346 (33.43%) were planned for inpatient admission (mean age 73.6) but 58 (16.8%) were discharged the same day. Overall 571 (55.17%) procedures were performed as day cases. Readmission rates for day-case and inpatient procedures were 7.4%, and 6.3% respectively ( p=0.48). Transfusion rates were lower in the day-case group (0.7% vs 3.7%, p<0.05). Day-case rates improved from 48.70% in 2011 to 75.22% in 2016. Conversion from day case to inpatient fell from 34.6% in 2011 to 14.8% in 2016. Conclusions: Our experience indicates that day-case transurethral resection of the prostate can be performed safely in appropriately selected patients, without increased rates of re-admission or complications. Level of evidence: 4 (Oxford Centre for Evidence-Based Medicine (CEBM)).

Varicose vein surgery under anti-platelet therapy

Phlebologie ◽  
2008 ◽  
Vol 37 (06) ◽  
pp. 287-297 ◽  
Author(s):  
P.-M. Baier ◽  
Z. T. Miszczak
Keyword(s):  
Varicose Vein ◽  
Bleeding Time ◽  
Varicose Veins ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Review Of The Literature ◽  
Varicose Vein Surgery ◽  
Anti Platelet Therapy ◽  
Male Patients ◽  
Acute Atherothrombosis

Summary Background: Platelet function inhibitors (PFI) are used for prophylaxis of atherothrombosis. These drugs cause a prolongation of the bleeding time and should eventually be stopped before an elective operation. However, there is a risk that a perioperative pause of PFI lead to acute atherothrombosis. Objective: Our aim was to study whether a discontinuation of PFI therapy is necessary to avoid bleeding complications in patients undergoing varicose vein surgery. Methods: Selective review of the literature and retrospective analysis of clinical data of our own patients. Results: In the years 2002 to 2007 a total of 10 827 patients have been operated on varicose veins, 673 (6.2%) of these aged 32–86 years (67 ± 7.9) receiving permanent PFI therapy: 256 male patients (38.0%) and 417 female (62.0%), 39.1% categorized as ASA III patients: male 11.6%, female 27.5%. 38 patients who continued PFI therapy did not demonstrate haemorrhagic complications and none of those pausing anti-platelet medication experienced thromboembolic complications. The literature survey confirmed our finding that it is not necessary to suspend PFI medication for varicose vein surgery as the bleeding risk can be controlled for by technical means. Conclusion: Discontinuation of PFI therapy prior to interventions on varicose veins does not seem to be necessary, further studies are essential though.

Recurrent varicose veins below the knee after varicose vein surgery

Phlebologie ◽  
2007 ◽  
Vol 36 (03) ◽  
pp. 132-136
Author(s):  
M. W. de Haan ◽  
J. C. J. M. Veraart ◽  
H. A. M. Neumann ◽  
P. A. F. A. van Neer
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Varicose Vein Surgery ◽  
Proximal Point ◽  
Perforating Veins ◽  
Recurrent Varicose Veins ◽  
Below The Knee ◽  
Duplex Imaging ◽  
Additional Value

SummaryThe objectives of this observational study were to investigate whether varicography has additional value to CFDI in clarifying the nature and source of recurrent varicose veins below the knee after varicose vein surgery and to investigate the possible role of incompetent perforating veins (IPV) in these recurrent varicose veins. Patients, material, methods: 24 limbs (21 patients) were included. All patients were assessed by a preoperative clinical examination and CFDI (colour flow duplex imaging). Re-evaluation (clinical and CFDI) was done two years after surgery and varicography was performed. Primary endpoint of the study was the varicographic pattern of these visible varicose veins. Secondary endpoint was the connection between these varicose veins and incompetent perforating veins. Results: In 18 limbs (75%) the varicose veins were part of a network, in six limbs (25%) the varicose vein appeared to be a solitary vein. In three limbs (12.5%) an incompetent sapheno-femoral junction was found on CFDI and on varicography in the same patients. In 10 limbs (41%) the varicose veins showed a connection with the persistent below knee GSV on varicography. In nine of these 10 limbs CFDI also showed reflux of this below knee GSV. In four limbs (16%) the varicose veins showed a connection with the small saphenous vein (SSV). In three limbs this reflux was dtected with CFDI after surgery. An IPV was found to be the proximal point of the varicose vein in six limbs (25%) and half of these IPV were detected with CFDI as well. Conclusion: Varicography has less value than CFDI in detecting the source of reflux in patients with recurrent varicose veins after surgery, except in a few cases where IPV are suspected to play a role and CFDI is unable to detect these IPV.

scholarly journals Comparison of Propofol and Thiopentone Anaesthesia (with Special Reference to Recovery Characteristics)

1987 ◽  
Vol 15 (4) ◽  
pp. 389-393 ◽  
Author(s):  
W. M. Weightman ◽  
M. Zacharias
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Day Case ◽  
Early Recovery ◽  
Day Case Surgery ◽  
Pain On Injection ◽  
High Incidence ◽  
Case Surgery ◽  
Repeated Doses ◽  
The Mean

Thiopentone and propofol were used for the induction and maintenance of anaesthesia in unpremedicated patients undergoing minor gynaecological procedures. There were no significant differences in the induction and maintenance characteristics except for a high incidence of pain on injection and a greater fall in the mean systolic blood pressure associated with propofol in comparison with thiopentone. Propofol was associated with a quicker early recovery as well as a faster psychomotor recovery, as tested by a peg-board. However, complete psychomotor recovery was not achieved for up to three hours in some patients receiving propofol and so caution is advised regarding the early street fitness of patients receiving repeated doses of the drug for day case surgery.

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