The benefits and caveats of day-case surgery (Tab 69.1 and Tab 69.2)

Financial

Every healthcare system in the world is under financial pres­sure. Day surgery operations cost less, saving expensive out of hours nursing and in-patient beds, which may be closed or used for more major surgery. Extra capital and resources may be needed to set up DSUs.

Better use of resources

Efficient throughput of patients makes more effective use of operating theatre time. Good organisation, patient selection and assessment can virtually eliminate last-minute cancella­tions and expedite admission on the day of surgery. DSUs should be ‘ring fenced’ against use for emergency cases so that admission as arranged is guaranteed.  

Care must be taken that complications do not increase owing to pressure to expand the range of day-case operations and that beds for the few inevitable patients who are unfit to go home are identified.

Reduction in waiting lists

Operations suitable for day surgery are usually those which can wait and so form a large part of waiting lists, which have usually been reduced where day surgery has been instituted. However, these more minor operations may be the first to be postponed or rationed when money runs out.

Patients

Day surgery would not have gained such widespread acceptance if patients did not prefer to go home after surgery, and numerous surveys have confirmed its acceptability to patients. Hospital-acquired infections, thromboembolism and pulmonary complications are reduced. For children in particular, day surgery is the ideal option because they spend as little time as possible away from their families and familiar surroundings, and most of the common operations of child­hood lend themselves to day surgery.

This assumes that patients are not sent home in discomfort or to inadequate care. Day surgery may simply pass the expense and burden of care to relatives and GPs, although this has not been found to be true in practice. A small percentage of patients have commented that insufficient attention was paid to home circumstances, that more information should be given before admission and that they were sent home before they felt well enough.