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Day Case Surgery by dr bhipi (2).pptx
- 1. Day Case Surgery Dr.Bhipi Chandra Ray Resident, Phase A, Urology, Year 02, Block-06 Bangabandhu Sheikh Mujib Medical University Presenter:
- 2. Outlines • Introduction • Daysurgery pathway • Patient selection criteria • Preoperative assessment, counselling & scheduling • Anaesthesia & analgesia • Advantages, disadvantages & barriers • Common day cases in paediatric surgery • Components of an emergency day case surgery • Discharge criteria
- 3. History of DaySurgery • James Henderson Nicoll a 19th century paediatric surgeon in Glasgow, is the father of day case surgery • Has nine thousand day surgeries in his dispensary • Believed in inpatient care to be waste of resources
- 4. What Is DayCase Surgery? • The admission of selected patients to hospital for a planned procedure, returning home on same day • It extends from first contact to final discharge of a patient • Success depends on each component of this pathway that will be safe, efficient & performed in sequence • Over 200 procedures are now considered to be suitable as day case
- 5. Types of DaySurgery Two types i. Elective day surgery ii. Emergency day surgery
- 6. Forms of AmbulatorySurgery • Day or same day surgery: admit & discharge in 12 hours • Procedure room surgery: No full sterile theatre facilities • Overnight stay: 23 hours admission with early morning discharge • Short stay surgery: up to 72 hours • Outpatient surgery: Not admitted to ward facility • Inpatient surgery: Requires more prolong admission
- 7.
- 8. Patient Selection Criteria •Low risk of significant immediate postoperative complications e.g. catastrophic bleeding or airway compromise • Patient is able to eat & drink or take oral nutrition postoperatively • Modern anesthetic facilities • Minimal access in abdomen or thorax Surgical criteria:
- 9. Continue… • No arbitrarycuts-off age, weight or criteria except comorbidities & functional status • Diabetes: Controlled HbA1C < 8.5%. Return asap to normal feeding after operation • Epilepsy: Not contraindicated if controlled • Obesity: Morbidly obese patients can be managed safely in expert hands with appropriate resources Medical criteria
- 10. Continue… • Suitable homeenvironment with a responsible, mentally & physically fit care giver • Drive at a hospital < 1 hour Social criteria:
- 11. Preoperative Assessment It hasthree essential components: • To educate patients & carers regarding day surgery pathways • Well-informed & well-prepared patient • To identify medical risk factors, promote health & optimize the patient's condition
- 12. Patient Counselling BeforeDay Surgery Ideally should include • Proposed operation & its details • Benefits, risks & complications of operation • Consequences if operation is not done • Alternative procedures or medications • Complications of anaesthesia
- 13. Scheduling • Day surgeryideally will be first on list with inpatient cases • Avoid complex inpatient cases on same day
- 14. Anaesthesia & Analgesia •Premedication & a multimodal analgesia approach • Short-acting general anaesthesia agents, day case spinal or regional anaesthesia techniques should be used to enable rapid recovery • TIVA using propofol offers better result with less PONV • Avoid long acting opiates, e.g. morphine to reduce sedation & PON
- 15. Advantages of DayCase Surgery For patient: • Significant reduction of hospital cost • Better comfort & greater control over patient’s personal life • Reduces risk of hospital acquired infection For hospital • Provide greater patient satisfaction • Increase availability of inpatient beds
- 16. Disadvantages of DayCase Surgery • Timing delay in operation day due to long queue • Burden of care passed on to family members • Good organization & management needed • Morbidity from anesthesia & surgery
- 17. Barriers to DaySurgery • Patient’s lack of awareness about benefits • Long distance from hospital to home • Inadequate infrastructure for transport • Long outpatient queues & operation dates
- 18. Common day casesin Paediatric Surgery • Ritual circumcision • Inguinal hernia • Hydrocele • Undescended palpable testes • Dermoid cyst • Abscess (Axillary, neck, perianal, groin)
- 19. • Sebaceous cyst •DJ stent removal • Tongue tie • Mucus retention cyst • Bakers cyst etc Continue…
- 20. Discharge Criteria • Vitalsigns stable for at least 1 hour • Correct orientation as to time, place & person if appropriate • Adequate pain control with supply of oral analgesia • Understands how to use oral analgesia that supplied • Ability to dress & walk where appropriate • Minimal nausea, vomiting or dizziness
- 21. Continue… • Has takenoral fluids • Minimal bleeding or wound drainage • Has passed urine • Has a responsible adult to take home • Written & verbal instructions given about post operative care • Knows when to come back for follow up • Emergency contact number supplied
- 22. Components of anEmergency Day Surgery • Identification of appropriate procedures • Ensuring clear pathways are in place • Determining whether the condition is safe to be left untreated for up to 24 hours & manageable at home with oral analgesia • Providing clear preoperative patient information, ideally in writing
- 23. Take Home Message •There is no difference in anaesthesia & surgical techniques between day case surgery & usual operation • Less disruption of patient’s domestic & social life • A cost saving approach for both patient & hospital
- 25.