Ureteroscopy in the day case setting: it’s worth it! Retrospective single surgeon outcomes analysis during service relocation (inpatient to daycase) in a DGH

2020 ◽  
pp. 205141582096287
Author(s):  
Darja Kremel ◽  
Dimitrios Siatos ◽  
Feras Al Jaafari
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Care Pathway ◽  
Surgical Techniques ◽  
Day Surgery ◽  
Flexible Ureteroscopy ◽  
Case Group ◽  
Day Case ◽  
Stone Treatment ◽  
Inpatient Group

Objective: Due to advances in surgical techniques and anaesthesia, day surgery is now becoming the standard care pathway for many complex procedures traditionally treated through inpatient pathways. Our aim was to study outcomes for patients undergoing rigid and flexible ureteroscopy before and after moving this service from a district general hospital to a day surgery unit. Methods: This was a retrospective observational study of 136 consecutive patients undergoing elective ureteroscopy for stone treatment. Half of the patients ( n=68, inpatient group) underwent treatment according to the standard inpatient pathway, while the other half underwent treatment following relocation of this service to a day case unit ( n=68, day case group). Outcomes were length of stay, readmission rate and complications. Results: In the inpatient group, 12 patients (17.6%) were discharged home the day of surgery (day 0), 42 patients (61.8%) stayed in hospital for one night. In the day case group, 58 patients (85.3%) were discharged on day 0, nine patients (13.2%) stayed for one night. Length of stay in the day case group was significantly shorter ( P<0.001). Rates of postoperative complications and readmissions were not significantly different. Conclusion: Day case ureteroscopy for stone treatment is feasible and safe. It is associated with a significantly reduced length of stay without an increase in postoperative complications or readmission.

scholarly journals Enhanced Treatment

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Firas Raheman ◽  
Raju Ahluwalia ◽  
Venu Kavarthapu
Keyword(s):  
Length Of Stay ◽  
Home Care ◽  
Home Therapy ◽  
Day Case ◽  
Day Case Surgery ◽  
Case Surgery ◽  
Surgical Fixation ◽  
Inpatient Group ◽  
Inpatient Management ◽  
Bed Days

Category: Ankle, Trauma Introduction/Purpose: Ankle fracture fixation has commonly been undertaken with an inpatient process due to swelling and surgery may not always be conducted on the next available operating list. In the UK there has been a move over the last 5 years to manage many trauma cases semi-electively and within the day case departments, to give patients more choice in their treatment. We conducted a study looking at the impact of a home therapy ankle pathway combined with day case- surgery on the length of stay and safety of patients with ankle fractures requiring surgical fixation conducted by group consultant trauma surgeons and their teams. Methods: Patients were assessed in two periods from Jan 2015 to Dec 2016; all patients were placed in a plaster of paris back slab in casualty with the ankle reduced, limb care advice given – elevation, cooling and DVT thromboprophylaxis. A group of patients were assessed for home therapy and day case surgery and were then discharged home on crutches after a slot was determined on a rapid access trauma list typically six days later. Patients who were not suitable for home therapy were excluded from review. We compared two cohorts of patients with weber B fractures whom choose surgical fixation, which would have been suitable for both day case and in-patient care over a 12-month period. We performed a prospective audit of the cases undertaken and analysis of the number of cases, complications and the cost benefits Results: 143-patients identified; 21 patients identified for home-therapy & day-case, and 32 patients for inpatient management. Within home-care & day case group: 1-tri-malleolar-fracture, 11-bi-malleolar fractures and 9-uni-malleolar and within inpatient group there were a similar mixture of fracture patterns. Time-to-surgery for inpatient management was 2.38 (1-16d) days; length of stay was 4.94 days (2-31d). Home-care & day-case time to surgery was 5.8 days (2-7). No patient admitted following surgery. All patients followed to pre-morbid ambulation levels. One DVT confirmed in the inpatient group no-wound-complications or failures of fixation reported. A mean 1.5 hrs operating time was required (59.3 min tourniquet time); day-case-surgery is £228 per patient cheaper than in- patient surgery. Cost efficiency based on 4.94 bed-day-improvement is 158 bed-days a cost-saving of £1,235 per patient. Conclusion: We believe home-care and day-case ankle fracture surgery is both valid and cost effective in optimizing the management of the appropriate ankle fractures without any significant rise in co-morbidity. For the patient there is little difference in waiting times and a pre planned surgical episode can give them flexibility to plan their treatment. The total potential saving per patient to the health care provider could be approx. £1,486 per patient. Furthermore, in our healthcare system it reduces demand for inpatient beds, provides significant cost savings for the provider and improves patient satisfaction due to choice and reduction wasted bed days

scholarly journals Day Ward Glaucoma Patients Have Lower Depression Levels and Higher Glaucoma Knowledge Levels than Inpatients

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Huiming Xiao ◽  
Wenmin Huang ◽  
Xi Qin ◽  
Chengguo Zuo ◽  
Qiongman Yang ◽  
...  
Keyword(s):  
General Condition ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Case Group ◽  
Hospital Anxiety ◽  
Day Case ◽  
Knowledge Questionnaire ◽  
Inpatient Group ◽  
The Difference ◽  
Baseline Demographic

Importance. Psychological factors and glaucoma knowledge are closely related to the effects of glaucoma treatment. Background. Studies comparing anxiety and depression levels and glaucoma knowledge between glaucoma day-case patients and inpatients are limited. Design. Randomized clinical trial. Participants. Consecutive patients undergoing surgery were prospectively enrolled. Methods. Patients were randomized into the day-case group or the inpatient group. All of the patients underwent corresponding procedures for treatment, care, and education. All participants were asked to complete the General Condition Questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Gray Glaucoma Knowledge Questionnaire (GGKQ) at admission and the HADS and GGKQ at discharge. Main Outcome Measures. The scores for the General Condition Questionnaire, the HADS, and the GGKQ. Results. In total, 216 patients were enrolled in this study, including 119 day ward patients and 97 inpatients. There were no significant differences between the two groups in terms of their baseline demographic and clinical data (P>0.05). The baseline HADS-anxiety (HADS-A), HADS-depression (HADS-D), and GGKQ scores were similar in both groups (P>0.05). Before discharge, the difference in HADS-A scores between the two groups was not significant; however, the HADS-D scores of the day-case inpatients were significantly lower (α = 0.05, P<0.001), and the GGKQ scores of day-case inpatients were significantly higher than those of the inpatients before discharge (α = 0.05, P<0.001). Conclusions and Relevance. Day ward patients had lower levels of depression and higher levels of glaucoma knowledge.

scholarly journals 242 Is Iliosacral Screw Fixation Safe to Perform in a Day Surgery Unit?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Crawford ◽  
C Brown ◽  
B Jones
Keyword(s):  
Blood Transfusion ◽  
Length Of Stay ◽  
Day Surgery ◽  
Iliosacral Screw ◽  
Day Case ◽  
Tertiary Referral Hospital ◽  
Surgical Time ◽  
Time Length ◽  
Iliosacral Screw Fixation ◽  
Larger Sample

Abstract Introduction Iliosacral screw (ISS) fixation is a percutaneous, fluoroscopy-guided technique which can be used to treat sacroiliac joint pain. During the covid-19 pandemic much of our elective practice has moved from the tertiary referral hospital to the local day surgery unit. We aimed to determine if this procedure is safe to perform as a day case procedure. Method Twelve patients underwent ISS between 2011-2017: 6 single ISS fixation, 4 two ISS fixation and 2 bilateral ISS fixation. All patients undergoing concurrent procedures were excluded. Mean age 44 years old (range 19-79); 58% male. Surgical time, length of stay, blood transfusion requirement, haemoglobin drop, and significant analgesic events were assessed. Results Average surgical time was 55 mins (single ISS; range 30-75 mins), 71 mins (two ipsilateral ISS; range 45-100 mins) and 105 mins (bilateral ISS; range 90-120 mins). All patients were discharged within 72 hours; 67% within 24 hours (4 single ISS, 2 two ISS, 2 bilateral ISS). There were no post-operative haemoglobin drops warranting blood transfusion and no delay to discharge due to significant analgesic events. Conclusions ISS fixation may be safe to perform in a day surgery unit due to acceptable surgical time, length of stay and complication rate. A larger sample size may be required to draw definitive conclusions.

scholarly journals Day-Case Rigid and Flexible Ureteroscopy

2007 ◽  
Vol 89 (5) ◽  
pp. 526-528 ◽  
Author(s):  
EJ Bromwich ◽  
R Lockyer ◽  
SR Keoghane
Keyword(s):  
Clearance Rate ◽  
Admission Rate ◽  
Day Surgery ◽  
Prophylactic Antibiotics ◽  
Flexible Ureteroscopy ◽  
Safe Procedure ◽  
Unplanned Admission ◽  
Day Case ◽  
Stone Clearance ◽  
Inflammatory Drugs

INTRODUCTION The aim of this study was to evaluate the feasibility of rigid and flexible ureteroscopy as a day-surgery procedure. PATIENTS AND METHODS All patients requiring elective ureteroscopy from March 2004 were considered for a day-surgery procedure. The standard day-surgery exclusions existed but there were no urological criteria for exclusion. A single consultant urologist performed or supervised all procedures. RESULTS A total of 64 patients underwent 50 rigid and 14 flexible procedures. Six diagnostic ureteroscopies were performed. There was a 96% stone clearance rate. Five patients required an unplanned admission within the first 2 weeks' postoperatively. Three of these patients were admitted on the day of surgery, two for pain and one for social reasons. Two patients were admitted at 24 h and 48 h, respectively, for urinary retention. CONCLUSIONS Ureteroscopy, both rigid and flexible, is a safe procedure for the day-surgery setting. Routine use of prophylactic antibiotics, intravenous non-steroidal anti-inflammatory drugs resulted in an acceptable re-admission rate.

scholarly journals Early Outcomes After Surgical Management of Geriatric Patella Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932098769
Author(s):  
Jaclyn Kapilow ◽  
Junho Ahn ◽  
Kathryn Gallaway ◽  
Megan Sorich
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Geriatric Patients ◽  
The United States ◽  
Unplanned Readmission ◽  
Patella Fracture ◽  
Factors Associated ◽  
Prolonged Hospitalization ◽  
Patella Fractures

Objectives: To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture. Design: Retrospective database review. Setting: The American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States. Patients/Participants: NSQIP patients over 65 years of age with patella fractures. Intervention: Surgical fixation of patella fracture including extensor mechanism repair. Main Outcome Measurements: Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications. Results: 1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V. Conclusions: Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes. Level of Evidence: Prognostic level III.

scholarly journals P17 An audit of Trakcare discharge times for Laparoscopic Cholecystectomy

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Initial Data ◽  
Best Practice ◽  
Average Length ◽  
Accurate Data ◽  
Day Case ◽  
Average Length Of Stay ◽  
Number Of Patients ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction Nationally 61,220 Laparoscopic Cholecystectomies are carried out annually. Those carried out as day-cases reduce providers’ costs and increase income through the best practice tariff. The system in our trust to record discharges is ‘Trakcare’. The aim of this audit was to accurately measure the discharge times of patients undergoing elective Laparoscopic Cholecystectomies, to try and reduce the number of patients recorded as having an overnight stay by accurate data collection. Methods Initial data was collected for all elective Laparoscopic Cholecystectomy discharge times on Trakcare, over a 1 month period. This data was then re-audited prospectively both from Trakcare and discharges reported by nurses/patients. A comparison was then made of Trakcare against reported discharge times. Results Initially 54 operations were recorded, with 30 completed as day cases (55.6%). The re-audited data (on Trakcare) recorded 47 operations, with 15 completed as day cases (37.91%). Of these discharges we were able to capture 26 (55.32%) manually, and 11 were completed as day cases (42.31%). Measuring these 26 with the same operations on Trakcare we were unable to show a difference in the number of cases completed as a day case (11 vs 11), with only a 33 minute decrease in the average length of stay. Conclusion Trakcare is a reliable tool for measuring the date of discharge for patients. The recommendations in are: scheduling surgery for a time pre-13:00 shows a higher proportion of patients discharged the same day, and continue to use Trakcare to record discharge times.

Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway

2021 ◽  
pp. 105566562110174
Author(s):  
Thomas R. Cawthorn ◽  
Anna R. Todd ◽  
Nina Hardcastle ◽  
Adam O. Spencer ◽  
A. Robertson Harrop ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cleft Palate ◽  
Care Pathway ◽  
Clinical Care ◽  
Oral Intake ◽  
Opioid Consumption ◽  
Complication Rates ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Clinical Care Pathway

Objective: To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. Design: Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). Patients: Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. Interventions: A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. Main Outcome Measures: Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. Results: Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 μg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. Conclusions: Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.

scholarly journals Questionable safety of thyroid surgery with same day discharge

2012 ◽  
Vol 94 (8) ◽  
pp. 543-547 ◽  
Author(s):  
HE Doran ◽  
J England ◽  
F Palazzo
Keyword(s):  
Surgical Procedures ◽  
Thyroid Surgery ◽  
Evidence Base ◽  
Day Surgery ◽  
Hospital Environment ◽  
British Association ◽  
Outpatient Basis ◽  
Day Case ◽  
Increased Risk ◽  
Same Day Discharge

INTRODUCTION Over the last two decades increasing numbers of surgical procedures have been performed on an outpatient basis. In 2000 the National Health Service in England set the target of performing 75% or more of all elective surgical procedures as day cases and in 2001 the British Association of Day Surgery added thyroidectomy to the list of day case procedures. However, same day discharge following thyroidectomies has been adopted by only a very small number of UK centres. The aim of this review was to establish the evidence base surrounding same day discharge thyroid surgery. METHODS The British Association of Endocrine and Thyroid Surgeons commissioned the authors to perform a review of the best available evidence regarding day case thyroid surgery as a part of a consensus position to be adopted by the organisation. A MEDLINE® review of the English medical literature was performed and the relevant articles were collated and reviewed. RESULTS There are limited comparative data on day case thyroid surgery. It is feasible and may save individual hospitals the cost of inpatient stay. However, the risk of airway compromising and life threatening post-operative bleeding remains a major concern since it is not possible to positively identify those patients most and least at risk of bleeding after thyroidectomy. It is estimated that half of all post-thyroidectomy bleeds would occur outside of the hospital environment if patients were discharged six hours after surgery. CONCLUSIONS Same day discharge in a UK setting cannot be endorsed. Any financial benefits may be outweighed by the exposure of patients to an increased risk of an adverse outcome. Consequently, 23-hour surgery is recommended.

scholarly journals Enhancing Safety in Epilepsy Surgery (EASINESS): Study Protocol for a Retrospective, Multicenter, Open Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Richard Drexler ◽  
Sharona Ben-Haim ◽  
Christian G. Bien ◽  
Valeri Borger ◽  
Francesco Cardinale ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Reference Values ◽  
Surgical Techniques ◽  
Mesial Temporal Lobe Epilepsy ◽  
Diagnostic Tools ◽  
Surgical Data ◽  
Mesial Temporal Lobe

Introduction: Optimizing patient safety and quality improvement is increasingly important in surgery. Benchmarks and clinical quality registries are being developed to assess the best achievable results for several surgical procedures and reduce unwarranted variation between different centers. However, there is no clinical database from international centers for establishing standardized reference values of patients undergoing surgery for mesial temporal lobe epilepsy.Design: The Enhancing Safety in Epilepsy Surgery (EASINESS) study is a retrospectively conducted, multicenter, open registry. All patients undergoing mesial temporal lobe epilepsy surgery in participating centers between January 2015 and December 2019 are included in this study. The patient characteristics, preoperative diagnostic tools, surgical data, postoperative complications, and long-term seizure outcomes are recorded.Outcomes: The collected data will be used for establishing standardized reference values (“benchmarks”) for this type of surgical procedure. The primary endpoints include seizure outcomes according to the International League Against Epilepsy (ILAE) classification and defined postoperative complications.Discussion: The EASINESS will define robust and standardized outcome references after amygdalohippocampectomy for temporal lobe epilepsy. After the successful definition of benchmarks from an international cohort of renowned centers, these data will serve as reference values for the evaluation of novel surgical techniques and comparisons among centers for future clinical trials.Clinical trial registration: This study is indexed at clinicaltrials.gov (NT 04952298).

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