The benefits
and caveats of day-case surgery
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.