OVERNIGHT STAY OF DAY SURGERY PATIENTS IN WRIGHTINGTON Mr Michael Walton Mr Jeremy Oakley Dr Raviprasad.Kattimani Dr Chetan Dojode

Aim of the Audit To address reasons for overnight stay in Wrightington after day surgery

Day Surgery Day surgery is best defined as “the admission of selected patients to hospital for a planned surgical procedure, returning home on the same day. True day surgery patients, are day case patients who require full operating theatre facilities and/or a general anaesthetic, and any day cases not included as outpatient or endoscopy”.

Benefits to patients Patients receive treatment that is suited to their needs and which allows them to recover in their own home. Cancellation of surgery due to emergency pressures in a dedicated day surgery unit is unlikely. The risk of hospital acquired infection is reduced.

Benefits to hospital Clinicians can provide high quality care for appropriate patients, and release inpatient beds for more major cases. Trusts can reduce waiting lists. Primary Care Trusts (PCTs) can commission cost-effective healthcare.

Methodology Data collected from 6th of August 2012 to 21st of February 2013 ( 7 months ). Inclusion :- Arthroscopic knee and shoulder cases. Exclusion :- Foot and Ankle, Hand surgery . Retrospective, EPR and clinical notes reviewed.

Results Data Number Total procedures of day cases 689 Over night stay 104 (15%) Average age 51.84 years Case notes obtained 79

Procedures Procedure Number Percentage Subacromial decompression 20 25.3 % Rotator cuff repair 15 18.9 % Diagnostic knee arthroscopy 3 3.7% Diagnostic shoulder arthroscopy 1 1.2% SLAP repair 5 6.3% MPFL reconstruction 2 2.5% Meniscectomy 23 30 % ACL reconstruction 8 10.1% Meniscus repair

Procedures

Reasons for stay 40.5% 33 7.5% 6 5% 4 20.25% 16 2.5% 2 8.8% 8 Reasons Percentage Number ANAESTHESIA 40.5% 33 MEDICAL 7.5% 6 SURGICAL 5% 4 SOCIAL PHYSIOTHERAPY 20.25% 16 MISCELLANEOUS 2.5% 2 NO REASONS FOUND PAIN RELIEF 8.8% 8 LATE THEATRE

Anesthesia related (n=32) Reasons Number percentage Nausea and vomiting 9 28.1 Giddiness 6 18.7 Post op retention Respiratory problems 3 9.3 Low oxygen saturation 4 11.2 Hypothermia 2 Tingling and numbness Block related 1 3.1

Anesthesia Type of Anesthesia GA Spinal 73 (91.1%) 6(7.9%) ASA GRADE 1 26 2 41 3 12

Medical reasons Reasons Number Asthma 1 Pulmonary embolism DVT High blood sugar Chest pain 2

Days of stay Number of days Patients Percentage 1 day 71 89.8% 2 days 4 5% 3 days 2 2.5% 4 days

Recommendations Anaesthetist need to look whether there are any recurring anaesthetic technique/drug issues which results in nausea, vomiting or giddiness. Guidelines for eligibility criteria for Day cases. Provision of Physiotherapy on same day. To exclude patients with multiple medical co morbidities. Re audit in 6 months.

THANK YOU