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.