PubMed · 6499582
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P H Lord. 1984. Day case surgery.. https://pubmed.ncbi.nlm.nih.gov/6499582/
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Day-case surgery is being used increasingly to improve health care efficiency. In Denmark, tonsillectomy is performed on an in-patient basis because of safety concerns regarding primary haemorrhage. This study aims at investigating the likely safety of day-case tonsillectomy by defining the incidence and timing of primary haemorrhage and thereby to establish a safe time period for a possible same day discharge. Retrospectively recorded data on 2,888 tonsillectomies were reviewed. Serious primary posttonsillectomy haemorrhage arose in 34 patients (2.7 percent), of which 65 percent presented within eight hours and 95 percent within 23 hours postoperatively. In view of the fact that one quarter of the patients with a primary posttonsillectomy haemorrhage experience it more than 12 hours postoperatively, tonsillectomy cannot be recommended as a safe routine day-case procedure.
BACKGROUND: Haemorrhoidectomy is commonly an inpatient procedure because patients and doctors worry about postoperative pain. Day-case haemorrhoidectomy (DCH) is possible if patient anxiety is addressed and postoperative pain and bowel function are managed. Pain sometimes increases a few days after haemorrhoidectomy, possibly because of secondary infection. We studied the effect of metronidazole on pain after DCH. METHODS: We randomly assigned 40 consecutive patients admitted for DCH metronidazole 400 mg (n = 20) or placebo (n = 20) three times daily, both for 7 days. All patients received lactulose from 2 days before surgery for 2 weeks. Diathermy DCH was performed without pedicle ligature or anal-canal dressing, and a diclofenac suppository was administered at the end of the procedure. Patients were discharged on the same day with diclofenac, 0.2% glyceryl-trinitrate ointment, lactulose, a telephone number to call for queries in emergencies, and an outpatient appointment. Patients took paracetamol or Co-dydramol (dihydrocodeine and paracetamol) as required; they completed linear analogue charts every day and completed questionnaires on satisfaction at 1 and 6 weeks. FINDINGS: 34 patients had all three major piles excised, of whom seven had additional division and reconstruction of the posterior skin bridge. Overall, both groups of patients experienced less pain than expected, except on days 3 and 4. Patients in the metronidazole group had significantly less pain than those in the placebo group on days 5, 6, and 7 (p = 0.004, p = 0.02, and p = 0.006). Median time to return to work or normal activity was 15 days (range 12-28) in the metronidazole group and 18 days (7-34) in the placebo group (p = 0.009). The patient satisfaction score was higher in the metronidazole group than in the placebo group at 1 week (p = 0.005). INTERPRETATION: Prophylactic metronidazole in diathermy DCH suppressed secondary pain around days 5-7 and increased patient satisfaction and earlier return to work.
PURPOSE: The preadmission assessment of patients one to two weeks preoperatively has become the standard across North America. We have devised a new approach that utilises a preoperative screening questionnaire, and this study attempted to determine the effectiveness of this technique. METHODS: Over six weeks, the attending anaesthetist for each patient undergoing non-cardiac surgery processed through the preadmission clinic (PAC) completed a study survey. This survey questioned if the assessment was appropriate with reasons, the consequences of no assessment, and if time was saved/lost on the day of surgery. RESULTS: Three hundred and seventy patients were processed (243 same-day (SD), 111 outpatient (O/P), and 16 inpatients (I/P)). Of these, 224 were assessed in the PAC (101 by medicine, 84 by anaesthesia and 39 by both): 42% (94) based on the questionnaire, 12% (26) due to consultation, and 46% (104) due to positive questionnaires and consultation. The physician assessments were appropriate 184/219 (84%) times, inappropriate in 35 (16%), while there was no answer for five. Assessments were inappropriate because 25/35 (71%) were unnecessary, while in nine (26%) the patient was not optimised. Of the patients not assessed in the PAC only 9/145 (6%) should have been assessed. CONCLUSION: The use of our screening tool in combination with direct referrals appropriately determines assessment needs of patients and allows for more efficient use of medical personnel in the PAC.