Historical

Day surgery is not a new concept. In 1909 James Nicoll, a Scottish surgeon, reported operating on nearly 9000 children as day cases, for operations such as talipes, correction of hare lip, hernia repair and mastoid surgery. His motivation was to save money and use resources better  reasons which are equally valid today. In the USA Ralph Waters, an anaesthetist, founded his ‘downtown anaesthesia clinic’ for dental and minor surgery in 1912, the prototype for the free-standing DSU. Despite acclaim for these innovations at the time, the concept was slow to gain acceptance, and it was only when the disadvantages of prolonged bed rest after surgery were appreciated in the 1940s that day surgery could really progress.

In 1951 Eric Farquharson, an Edinburgh surgeon, carried out day-case adult hernia repairs under local anaesthesia in order to reduce long waiting lists in the newly introduced

National Health Service (NHS). He initiated policies o~ careful patient assessment and cooperation with general practitioners (GPs) to ensure care after discharge. Hospital-based DSUs began to appear in the United States in the 1960s, and in 1969 Walter Reed, an American surgeon, set up the Phoenix Surgicenter, the first free-standing DSU. UK hospitals followed suit from the 1970s and DSUs became established in most hospitals, although the free-standing DSU is almost unknown in the UK.

Day surgery now began to take on a momentum of its own, and influential reports such as those from the Royal College of Surgeons of England in 1985 and 1992, and the Audit Commission in 1990, focused attention on the benefits of day surgery and set standards and guidelines.