Day Case Surgery 1l

DAY CASE SURGERY
Dr. Hiwa Omer Ahmed

professor in General Surgery
1 Tuesday, November 27,

2018
Introduction
Day surgery is an increasingly important part of elective

surgery
50 per cent of elective surgery in the UK
60 per cent or more in the USA and Canada
80 % in Kurdistan
The impetus for this has been

1.the high cost of keeping patients in in-patient beds,
2. the reduction in availability of these beds
3.long surgical waiting lists in publicly funded healthcare
systems.

2018
Improvements in the following have all
promoted the expansion of day surgery.
1.anaesthesia
2.pain control
3.minimally invasive surgery
4.changing attitudes to recovery after
surgery

2018
Patients, particularly children,
benefit from reduced stays in
hospital and a rapid return to their
home environment
2018
Definition
Day surgery is defined as
planned investigations or procedures on patients who
are admitted and discharged home on the day of
their surgery but require some facilities and time for
recovery.
In most countries, this means that the patient
spends a few hours in hospital and does not stay
overnight.
Includes patients who may spend up to 23 hours
in hospital, allowing a greater range of
procedures to be included.

2018
The benefits of day-case surgery
1.Financial
2.Better use of resources
3.Reduction in waiting lists
4.Decreased hazards of inpatient;
a. Hospital-acquired infections
b.Thromboembolism and pulmonary complications
are reduced.
c. For children in particular, day surgery is the
ideal option
2018
Postoperative morbidity after day
surgery
Day surgery has an excellent safety record.
In a large study from the Mayo Clinic in

1993, Warner reported that the mortality
and major morbidity in the 30 days after
day surgery was 0.0007 per cent — lower
than in the general population who had no
surgery.

2018
Minor morbidity, however, is common.
Postoperative morbidity is related to
1.the type of anesthesia used
2.the surgery itself.
The procedure is generally the most
important predictor of complications.

2018
The essentials of good day surgery
the following are essential:

1. selection of appropriate procedures and
patients;
2. preadmission assessment and information;
anaesthesia and surgery with minimal morbidity
and complications;
3. postoperative and postdischarge analgesia;
4. discharge criteria and postoperative instructions;
5.follow-up and audit.
2018
Day surgery selection
In selecting suitable procedures and

patients, consider:
• the procedure to be undertaken;
• the social circumstances;
• the fitness of the patient.

2018
Criteria for suitable day-case
procedures
• Minimal physiological trespass;
• not associated with excessive blood loss or fluid
shifts;
• very low risk of serious postoperative
complications (e.g. bleeding or airway
obstruction);
• duration of up to 1 hour, 2 hours maximum;
• pain must be controllable with oral analgesics
after discharge;
• the patient should be reasonably ambulant
afterwards

2018
The social circumstances
1. Day surgery needs ready access to a
hospital or GP after discharge,
2. A responsible adult to escort the patient
home and care for them at least until the
following morning is mandatory.
3.Patients must have reasonable home
circumstances with good toilet facilities,
few stairs to climb and access to a
telephone.
2018
4.Patients should live within 60 minutes’
travelling distance, both to reduce
discomfort on the way home and to have
ready access to hospital care if needed.
Patients should not travel home by public
transport.
Developing countries with long
distances and difficult traveling
conditions to reach medical care may
find that these are obstacles to
introducing day surgery.
2018
The fitness of the patient for
general anesthesia
The patient should be medically stable and have
been screened before admission to exclude
major health problems.
1.The American Society of Anesthesiologists
(ASA)
2.Age; 70 is often taken as an upper age limit,.
The lower age limit depends on the facilities
available, the experience of the staff and the
procedures undertaken.

2018
3.Obesity. Weight limits expressed as body mass
index (BMI) are often imposed, Surgery and
anaesthesia are undoubtedly more difficult and
have more complications in overweight patients,
who may also have more health problems.
Although a BMI of 30 is often taken as an upper
limit, in otherwise fit patients problems do not
really become apparent until the BMI exceeds
35.

2018
4.Respiratory disease.
5.Hypertension.
6.Cardiac disease.
Unsuitable conditions include
cardiac failure
symptomatic valvular disease
severe or rest angina
fast ventricular arrythmias
unpaced second or third degree heart block
myocardial infarction within the previous 6
months..
.
2018
7.Diabetes. Well controlled noninsulin-dependent
diabetes (NIDDM) usually poses no problems.
8.Drug therapy. anticoagulants, systemic steroids,

digoxin, drugs for dysrrhythmias and angina,
and monamine oxidase inhibitors need individual
anaesthetic evaluation before booking for day
surgery.
Oestrogen containing oral contraceptives need not

be discontinued except for lower limb
operations, particularly where a tourniquet will
be used.
2018
Post OP
1.Analgesia ;Good pain control is essential.
It is a major reason for delay in discharge,
2. early patient mobilisation shortens
return to normal function.

2018
Criteria of discharge
1.Stable vital signs
2.Up to Mild pain & nausea
3.Could move alone and walk
4.Could dress him self
5.Not needs parentral drugs
6. There are some one to take care of him at home
7.Not far more than 60 minutes drive
8. Could take orally

2018

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DAY CASE SURGERY

Dr. Hiwa Omer Ahmed

1 Tuesday, November 27,

Day surgery is an increasingly important part of elective

The impetus for this has been

2 Tuesday, November 27,

3 Tuesday, November 27,

5 Tuesday, November 27,

In a large study from the Mayo Clinic in

7 Tuesday, November 27,

8 Tuesday, November 27,

the following are essential:

In selecting suitable procedures and

10 Tuesday, November 27,

11 Tuesday, November 27,

14 Tuesday, November 27,

15 Tuesday, November 27,

8.Drug therapy. anticoagulants, systemic steroids,

Oestrogen containing oral contraceptives need not

18 Tuesday, November 27,

19 Tuesday, November 27,

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