Day care or ambulatory surgery involves performing surgical procedures on patients who are admitted and discharged from the hospital on the same day, requiring only a few hours of post-operative monitoring and care. The modern era of day surgery began following World War II with the realization that prolonged bed rest led to higher complication rates. Several milestones included the opening of the first day surgery units in the US in 1951 and UK in 1969, as well as the establishment of professional organizations supporting day surgery. Over 200 procedures are now routinely performed as day cases, including many general surgery procedures like laparoscopic cholecystectomy. Success depends on careful patient selection, pre-op assessment and stabilization, well-planned anesthesia, good post-op pain and

1. Day care surgery
Department of General and
laparoscopic surgery
Presenter: Dr Anjani shah
1st year junior resident.

2. Definition
In the UK the definition of day surgery is the
admission of selected patients to hospital for a
planned surgical procedure, returning home on
the same day

3. Bailey & Love's Short Practice of Surgery 27th Edition

5. • The modern era of day surgery began in the
years following World War II with the
realization that prolonged bed rest was
associated with high rates of postoperative
complications.
1951
First hospital based day
surgery unit open in US
1969
First hospital based day
surgery unit open in UK
1989
British association of day
case surgery(BADS)
1995
International
association of
ambulatory
surgery

6. Day care surgery
• Need some degree of specialized post op
nursing care
• Need post op observation for few hours
• Admitted usually in morning ,operated same
day and discharged in case of smooth
recovery

7. • The British Association of Day Surgery’s
(BADS) Directory of Procedures lists over 200
procedures that are now considered to be
suitable as a day case
• surgical procedures lasting 3–4 hours are now
being routinely performed as successful day
cases
Bailey & Love's Short Practice of Surgery 28th Edition

8. Patient selection
Bailey & Love's Short Practice of Surgery 28th Edition

9. Social criteria
• Responsible adult or supervisor at home
• Home circumstances
• The patient should live within a 1-hour drive
of a hospital.

10. Procedure selection
• Minimal physiological alteration
• Not associated with excessive blood loss
• Low risk of serious post op complication
• Pain must be controllable with oral analgesics
• Early ambulation possible
• The patient should be able to eat and drink or
take oral nutrition postoperatively.

11. Medical exclusion to day care surgery
• Unstable ASA 3
• ASA 4 or 5
• Any poorly controlled
abnormality/comorbidity

12. Bailey & Love's Short Practice of Surgery 27th Edition

13. Success depends on
• Patient selection
• Pre-op assessment and stabilization
• Well planned anesthesia
• good treatment of post op pain and vomiting
• Good extended care
• Cooperative patients with a responsible adult
with phone number and email

14. Specialty surgery performed
• General surgery
• Orthopedics
• Gynecology
• Ent
• Eye
• Plastic surgery
• Urology

15. Examples from general surgery
• Diagnostic laparoscopy
• Laparoscopic cholecystectomy
• Laparoscopic appendectomy
• Laparoscopic hernioplasty
• Laparoscopic incisional hernia repair
• Gastroscopy, colonoscopy
• Thyroid lobectomy
• herniorraphy

16. Bailey & Love's Short Practice of Surgery 28th Edition

17. Bailey & Love's Short Practice of Surgery 27th
Edition

19. Discharge criteria
• Stable vitals sign
• Oriented, taking
• Adequate pain control
• No bleeding
• Minimal nausea, vomiting
• Has passed urine
• Has responsible adult to take home
• Emergency contact number supplied

20. Advantage of day care surgery
• Reduce cost
• Reduces waiting list for elective surgery
• Inpatient beds available for major elective
surgery

21. • Low incidence of post-op morbidity
• Low incidence of thrombo-embolism
• Low incidence of hospital acquired infections
• Early return to work
• Minimal disturbance to normal routine life

22. Disadvantages of day care surgery
• Initial high cost setting up day care unit
• Good organization and management needed
• Poor patient and procedure selection can be
dangerous
• Inadequate information given to patient
• Burden of care transferred to patient family.

23. Day care surgery in Nepal
• Total 35 patients underwent laparoscopic
cholecystectomy. Age range was between 16-65 years
during September to november,2017 in kathmandu
medical college and teaching hospital, kathmandu.
• 25 Patients were advised for discharge but only 10
could make arrangement
• Only 1 patient needed readmission and Complications
observed were minor and relatively few.

24. References
• Bailey and love’s short practice of surgery
(27th edition)
• International association of ambulatory
surgery handbook (2nd edition)