CPOC: Day Surgery

Question 1

Day-case surgery facilities

Answer 1

• Ideally a purpose-built, self-contained unit with its own pre-operative, intra-operative and post-operative facilities.
• Contained within a main hospital or with access to higher-level support services (e.g. HDU) if required
• Separate from inpatient activity

Question 2

Surgical factors when considering whether a case should be day-case

Answer 2

• Can the patient reasonably be expected to manage E&D post-operatively
• Can the pain of the procedure be managed with simple oral analgesics +/- regional anaesthesia
• Low risk of significant immediate post-operative complications
• Will the patients require mobility aids post-operatively and if so can this be taught in advance

Question 3

Social factors when considering whether a case should be day-case

Answer 3

• Within one hour’s drive of the hospital
• Carer for at least 24 hours post-operatively

Question 4

Medical factors when considering whether a case should be day-case

Answer 4

• Any poorly controlled comorbidity
• Infants under 60 weeks of corrected age
• Severe OSA in tonsillectomy patients

Question 5

Principles of anaesthesia for day-case surgery

Answer 5

• Pre-medicate with oral analgesia
• Short-acting anaesthetic agents only- TIVA good for anti-emetic effects
• Avoid emetogenic drugs
• Effective use of regional anaesthesia
• Multimodal analgesia
• Short-acting opioids as rescue only
• Good post-operative analgesia

Question 6

Key discharge criteria for day-case surgery

Answer 6

• Pain controlled with oral analgesia
• Nausea and vomiting controlled
• Tolerating oral fluids
• Can mobilise safely
• Stable observations