Day Case Surgery

Question 1

Day Case Surgery

Answer 1

Admission and discharge of the patient within 12 hours.

Question 2

Inpatient surgery

Answer 2

Patient is admitted to ward

Question 3

Outpatient surgery

Answer 3

Patient is not admitted to a ward

Question 4

Procedure room surgery

Answer 4

A surgery that doesnt require OT facilities

Question 5

Overnight stay

Answer 5

Stay for 23 hours with early morning discharge

Question 6

Short stay surgery

Answer 6

Stay for 72 hours (3 days)

Question 7

Selection Criteria for Day Case Surgery

Answer 7

1- medical criteria
2- social criteria
3- surgical criteria

Question 8

Medical criteria

Answer 8

1- age: no age limit. Only physiological health is considered.
2- comorbidity: ASA 1 and 2 for stand alone units and ASA 3 for hospital integrated units.
3- BMI: less than 40 for surface surgery and less than 38 for laparoscopic surgery.

Question 9

Social criteria

Answer 9

Patient has adult carer for next 24 hours atleast.

Hospital is within 2 hour distance of home and/or there is comfort of travelling.

Question 10

Surgical criteria

Answer 10

Operations up to 2 hours long.
Minimal access surgery with minimum trauma.
Suitable control of pain and ability to eat and drink within a reasonable time scale.

Question 11

Scheduling in day case surgery

Answer 11

Major procedures and procedure requiring general anesthesia should be first on the morning list.
Local anesthesia cases should be on evening list.
In mixed lists of both day case and inpatient surgeries. Day case should be done first.

Question 12

Anesthesia and analgesia in day case surgeries

Answer 12

Multimodal analgesia with NSAIDs and paracetamol.
In anesthesia TIVA is used with short acting opioids like remifentanil. Alfentanil. Fentanyl.
If morphine is to be used. It should be used in small dose.
Morphine increases risk of postoperative nausea and vomiting (PONV).
Long acting local anesthetic like bupivacaine should be injected into the surgical wound.

Question 13

Treatment of PONV

Answer 13

Give IV fluids.
And IV cyclizine. Prochlorperazine.

Review after 1 hour.

Give ondansetron. Dexamethasone.

Give patient option of being admitted or discharged.

Question 14

Abdominal procedures which can be done on day case basis

Answer 14

Inguinal hernia repair. 
Femoral hernia repair. 
Anal lesion excision.
Hemorheroidectomy 
Lap chole 
Laparoscopic fundoplication 
Pilonidal sinus surgery

Question 15

Breast surgeries that can be done on day case basis

Answer 15

Excision of breast lesion

Sentinel node excision

Question 16

Genitourinary surgeries that can be done on day case basis

Answer 16

Laser prostatectomy
Orchidectomy
Circumcision
Excision of hydrocele. Varicocele. Epididymis

Question 17

Orthopaedic surgeries that can be done on day case basis

Answer 17

Dupuytrens fasciectomy 
Carpet tunnel release 
Therapeutic arthroscopy of knee or shoulder 
Bunion operation
Removal of metalwork

Question 18

Vascular surgeries that can be done on day case basis

Answer 18

Varicose vein procedures

Thoracoscopic sympathectomy

Question 19

Discharge criteria in day case surgeries

Answer 19

Vital signs stable for more than a hour. 
Patient is taking oral fluids. 
Has passed urine. 
Has an adult carer for next 24 hours. 
Emergency contact number provided. 
Postdischarge instructions given. 
Adequate pain control.