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.

Major ear surgery in a paediatric day care unit

2002 ◽  
Vol 116 (10) ◽  
pp. 791-793 ◽  
Author(s):  
R. G. Rowlands ◽  
R. Harris ◽  
J. Hern ◽  
J. R. Knight
Keyword(s):  
Outcome Measure ◽  
Admission Rate ◽  
Day Surgery ◽  
Unplanned Admission ◽  
Day Case ◽  
Ear Surgery ◽  
The Usa ◽  
Unplanned Admissions ◽  
Mastoid Surgery ◽  
Case Basis

Abstract Traditionally major ear surgery in children has been regarded as an in-patient procedure. Evidence from the USA for adults, however, concludes that it is both safe and effective to perform many major ear procedures as day cases. We have been carrying out major ear operations on children as day cases routinely for six years in a dedicated children’s day unit and examined our data to find out whether it was both safe and feasible to perform major ear surgery in children on a day-case basis. As our main outcome measure we used the rate of unplanned admissions.We found that the unplanned admission rate for surgery, excluding mastoid surgery, was 6.7 per cent and that procedures such as myringoplasty, ossiculoplasty, bilateral pinnaplasty, meatoplasty and tympanotomy with excision of cholesteatoma, were eminently suitable for day surgery.

scholarly journals Day-Case Septoplasty and Unexpected Re-Admissions at a Dedicated Day-Case Unit: A 4-Year Audit

2006 ◽  
Vol 88 (2) ◽  
pp. 202-206 ◽  
Author(s):  
Christos Georgalas ◽  
Rupert Obholzer ◽  
P Martinez-Devesa ◽  
G Sandhu
Keyword(s):  
Patient Satisfaction ◽  
Admission Rate ◽  
Day Surgery ◽  
Case Note ◽  
Day Case ◽  
Retrospective Case ◽  
Patient Factors ◽  
Factors Associated ◽  
Septal Surgery ◽  
Submucous Resection

INTRODUCTION Septal surgery has been identified as suitable for day-surgery, but is not widely performed as such. Guidelines for day-surgery state that the unexpected admission rate should be 2–3%. Previous audits have not achieved this figure and septoplasty is not universally considered suitable for day-surgery. We have reviewed practice over 4 years in our institution to identify surgical and patient factors associated with unexpected admission following septoplasty. PATIENTS AND METHODS A retrospective case note based audit of day-case septoplasty procedures reviewed at the end of each year between October 1998 and October 2002. RESULTS A total of 432 septal surgery procedures were performed, comprising 378 septoplasties and 54 submucous resections. Thirty-eight patients were admitted, overwhelmingly because of haemorrhage in the immediate postoperative period, giving an overall admission rate of 8.8% within the first 24 h. Factors associated strongly with re-admission were the use of intranasal splints, the performance of revision surgery, submucous resection (as opposed to septoplasty) and, less so, the performance of additional procedures and the peri-operative administration of diclofenac. There was no correlation between unexpected admission and grade of surgeon, surgical technique or any of the patient factors analysed. CONCLUSIONS The unexpected admission rate of septal surgery performed at our unit is above that recommended for day-case procedures, but is within the range previously published. Patient satisfaction with day-case septoplasty has been shown to be high. We believe that septoplasty should be performed in this setting but there is a significant chance that patients may need admission, and a pathway should be in place for this to occur with minimal disruption to the patient.

Role of a home care team in paediatric day-case tonsillectomy

2001 ◽  
Vol 115 (1) ◽  
pp. 39-43 ◽  
Author(s):  
C. Shah ◽  
R. Shahab ◽  
P. Robb ◽  
D. Roy
Keyword(s):  
Home Care ◽  
Admission Rate ◽  
Care Team ◽  
High Morbidity ◽  
Unplanned Admission ◽  
Day Case ◽  
Case Rate ◽  
Telephone Calls ◽  
Haemorrhage Rate

The feasibility of paediatric day-case tonsillectomy (PDCT) depends on its safety and acceptance by parents and patients. The purpose of our retrospective study of paediatric day-case tonsillectomy was to review the role of the home care team (HCT) in improving the safety and acceptance of the procedure.Between January 1997 and June 1999, 352 consecutive children underwent day-case tonsillectomy. The notes and HCT assessment sheets were reviewed for telephone calls made by HCT or by parents, home visit by HCT, types of complication and their outcome.The primary haemorrhage rate was 0.6 per cent. The effective day-case rate was 97 per cent. The unplanned admission rate was three per cent. The HCT visited about 25 per cent of patients at home. We conclude that paediatric day-case tonsillectomy is associated with high morbidity and considerable parental anxiety that can be dealt with by timely reassurance, support and advice by a dedicated HCT.

scholarly journals Laparoscopic Cholecystectomy as a Day Surgery Procedure

1996 ◽  
Vol 24 (2) ◽  
pp. 231-236 ◽  
Author(s):  
R. J. Singleton ◽  
G. E. Rudkin ◽  
G. A. Osborne ◽  
D. S. Watkin ◽  
J. A. R. Williams
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Recovery Room ◽  
Admission Rate ◽  
Day Surgery ◽  
Nausea And Vomiting ◽  
Day Case ◽  
Hospital Admission Rate ◽  
Admission Rates ◽  
Surgery Patient ◽  
At Home

Outcome is presented for 40 consecutive laparoscopic cholecystectomies performed in a public teaching hospital day surgery unit. The unanticipated hospital admission rate on the day of surgery was 17.5% (seven patients) and the majority of these (12.5%; five patients) were due to surgery-related considerations. Two other admissions were due to nausea and vomiting. One patient was admitted to hospital on the second postoperative day with nausea and vomiting. Procedure duration for the day cases averaged 98 minutes (SD25; range 60–167). Recovery room times before discharge averaged 272 minutes (SD 58; range 125–365). Each day surgery patient averaged 3.3 postoperative home visits from community nurses. Most patients (94%) mobilized at home by the second postoperative day and 85% resumed normal activities of daily living by two weeks. At follow-up, 25 patients (76%) stated they were happy to spend the first night at home, but seven (21%) would have preferred to remain in hospital for the first postoperative night. Laparoscopic cholecystectomy can be performed successfully as a day–case procedure, but long operating and recovery room times and potentially high admission rates suggest that these factors should be considered in cost equations for day-case management of this procedure.

scholarly journals Ketorolac or Pethidine for Analgesia after Elective Laparoscopic Sterilization

1995 ◽  
Vol 23 (2) ◽  
pp. 158-161 ◽  
Author(s):  
L. Cade ◽  
P. Kakulas
Keyword(s):  
Admission Rate ◽  
Day Surgery ◽  
Double Blind Study ◽  
Unplanned Admission ◽  
Double Blind ◽  
Analgesic Effects ◽  
Recovery Times ◽  
Laparoscopic Sterilization ◽  
Unplanned Admissions ◽  
Intramuscular Ketorolac

Laparoscopic sterilization is commonly performed as a day surgery procedure despite difficulties in providing adequate postoperative analgesia for all patients. We have examined the analgesic utility of intramuscular ketorolac in this setting by comparing it with intramuscular pethidine, both given after induction in a randomized, double-blind study in sixty such patients. Although the analgesic effects of the two drugs were comparable in the immediate postoperative period, ketorolac provided significantly better analgesia four hours after surgery (pain score of 2.7 v. 4.2, P=0.006). The recovery times taken to awake, to ambulate and for discharge were all significantly shorter after ketorolac (4.6 v. 8.8 min, P=0.01; 178 v. 260 min, P=0.0005; 242 v. 320 min, P=0.02), and the unplanned admission rate was also significantly less after ketorolac (7% v. 33%, P=0.01). Ketorolac appears to be a useful supplement for analgesia after laparoscopic sterilization, providing improved analgesia as well as decreased recovery time and fewer unplanned admissions.

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.

A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision

2018 ◽  
Vol 28 (10) ◽  
pp. 924-929 ◽  
Author(s):  
David Joel Stoeter ◽  
Stephen Roberts
Keyword(s):  
Admission Rate ◽  
Care Bundle ◽  
Unplanned Admission ◽  
Day Case

Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience

2021 ◽  
pp. 205141582098766
Author(s):  
Joseph B John ◽  
Angus MacCormick ◽  
Ruaraidh MacDonagh ◽  
Mark J Speakman ◽  
Ramesh Vennam ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Local Anaesthetic ◽  
Complication Rate ◽  
Admission Rate ◽  
Prophylactic Antibiotics ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Hospital Admission Rate ◽  
Prostate Biopsies ◽  
Disease Characteristics

Objectives: This study aimed to describe a UK institution’s experience with local anaesthetic (LA) transperineal (TP) prostate biopsies (PB), and to report 30-day complications following LATPPB, including a large cohort that did not receive antibiotic prophylaxis. Patients and methods: A prospective database of 313 consecutive patients undergoing LATPPB was maintained, describing patient and disease characteristics, and complications. From September 2019 to January 2020, antibiotic prophylaxis was given before LATPPB ( n=149). Following a change to routine care, from January 2020 to July 2020, prophylactic antibiotics were not given before LATPPB ( n=164). A comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation using electronic hospital and primary care records. Results: Patient and disease characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of PB and prostate cancer cohorts described in the urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis. The overall complication rate was 0.64%, and 0.61% for those not receiving antibiotic prophylaxis. There were no severe (Clavien–Dindo 3–5) complications. The unplanned hospital admission rate was 0.64%. Conclusion: The complication rate after LATPPB was low, with no infection-related complications in patients who did not receive antibiotic prophylaxis. This provides further evidence supporting the discontinuation of routine prophylactic antibiotics before TPPB. Level of evidence: Level 2b.

Comparison between different techniques for management of renal stones in horseshoe kidneys

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Abdel Fattah Mohammed Aggour ◽  
Mohamed Kotb Ahmed Tolba ◽  
Abdelrahman nazmy abbas hatata
Keyword(s):  
Horseshoe Kidney ◽  
Renal Stones ◽  
Operative Management ◽  
Flexible Ureteroscopy ◽  
Stone Clearance ◽  
Stone Burden ◽  
Laparoscopic Pyelolithotomy ◽  
Almost All ◽  
Laparoscopic Assisted ◽  
Operating Surgeon

Abstract Objective To report the operative management , intra and post operative complications and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidneys. Materials and Methods We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 20-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. Results In all, 80 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 28 patients. 12 patients had laparoscopic assisted PCNL , 8 had flexible ureteroscopy and 18 had laparoscopic pyelolithotomy . PCNL was used for large stones = (mean digitized surface area= 614.32 mm 2 ) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures. only 33% of patients treated with flexible ureteroscopy was cleared from stones in one session and surprisingly, 89% of patients treated with laparoscopic pyelolithotomy was stone free after one session Complications were minimal, with 15% minor and 3% major complications in the PCNL group only.. Conclusions Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.

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.

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