Delhi/NCR:

MOHALI:

Dehradun:

BATHINDA:

BRAIN ATTACK:

CONSIDER DAY CARE SURGERY AS DEFAULT FOR ALL ELECTIVE SURGERY – ASK WHY NOT? RATHER THAN WHY?

By Dr. Manish Rai in Anaesthesia

May 23 , 2018 | 3 min read

3

Daycare Surgery, also known as outpatient surgery, office-based surgery, same day surgery or ambulatory surgery does not require an overnight hospital stay. Daycare Surgery is not to be confused with 23 hours of stay surgery which is Inpatient surgery with a 1-day length of stay. For daycare procedure patient must be admitted, operated upon and discharged home on the same calendar day. Usually, a stay of 4 – 6 hours is required but with more complex surgical procedures, longer stays may be required.

Dr. Manish Rai, Senior Consultant - Anaesthesiology & Head - Day Care Unit says, Daycare Surgery has grown in popularity due to improved surgical techniques, better anaesthetic drugs and saving the patient time that would otherwise be wasted on the hospital bed. About 60 – 65 % of all elective surgical procedures can be done on outpatient basis.

What are Daycare Surgical Centers?

Daycare Surgical centres or outpatient surgical centres are Healthcare facilities, where surgical procedures not requiring an overnight stay are performed.

Patient and procedure selection for daycare Surgeries:

It is very important that correct patient selection is done to ensure the success of the daycare programme. According to the procedure planned and general physical condition of the patient, different modalities of anaesthesia can be planned:

  • Local Anesthesia
  • Monitored Anesthesia Care
  • Regional Anesthesia
  • General Anesthesia

Criteria considered in selecting patients for day surgery include: ƒ

  • Patients must be assessed as American Society of Anesthesiologists (ASA) classes I or II. However, ASA class III & IV can also be taken up in a well established Day Care Surgical Centre.
  • Operations should preferably not go beyond one and half hour duration.
  • Operations involving excessive blood loss or postoperative severe pain should be disqualified. ƒ
  • Patient’s general health and social conditions are the major criteria, although these may be relaxed for surgery under local anaesthesia.
  • Morbid obese and anxious patients and those who have a strong wish for inpatient treatment should be excluded.

The advantages of daycare surgeries:

  • More economical for the patient in comparison to inpatient surgery.
  • Earlier mobilization.
  • Reduced risk of cross-infection.
  • Pre-booked date and less likely to be cancelled.
  • Shorter waiting lists and lesser uncertainty of a long wait.
  • Easier domestic arrangements.
  • Minimal disruption of patient's personal life. ƒ
  • Earlier return to the normal environment. ƒƒ
  • Avoidance of disruptive nights in hospital wards. ƒ
  • Less loss of time at work.ƒ
  • Less psychological disturbances in children and elderly patient.
  • Lesser chances of cancellation due to pressures of emergency surgeries in a dedicated daycare facility.

ON THE DAY OF YOUR SURGERY:

  • Leave all money and valuables at home (including jewellery and keys).
  • Take a shower or bath before you come to the hospital.
  • Wear loose, comfortable clothing.
  • Remove all make-up, contact lenses and nail polish.
  • A family member or friend must be available to take you home after your procedure.
  • It is important to share all medical information with the surgical daycare Unit staff (i.e.: reaction to medication, anesthesia, difficulty hearing etc.).

Day Care Surgery is done for:

Dental Procedures: 

1. Dental procedures for pediatric age group

2. Jaw Surgeries – single jaw procedures

o   Upper jaw advancement

o   Upper Jaw set back

o   Upper jaw impaction ( correction of Gummy smile)

Teeth socket bone fractures

Ø  Conservative management of lower/ upper jaw fracture

Ø  Cysts removal

Ø  Full mouth dental implants placement

Ø  All four third molars surgical removal under general anesthesia

Ear, Nose & Throat:

Ø  Adenoidectomy

Ø  Tonsillectomy

Ø  Adenotonsillectomy

Ø  Micolaryngeal surgery

Ø  Impacted wax removal from ears

Ø  Tympanoplasty

Ø  Cauterisation of bleeding points in children

Ø  Myringotomy and grommet insertion

Ø  Tongue tie release

Ø  Septoplasty

Ø  Embedded ear/nose stud removal

Ø  Ear lobe repair

Ø  Sleep endoscopy

General Surgical Procedures:

Ø  Fissurectomy

Ø  Fistulectomy

Ø  Laparoscopic Cholecystectomy

Ø  Open inguinal hernia repair

Ø  Open umbilical hernia repair

Ø  Laparoscopic adhesiolysis

Ø  Hemorrhoidectomy (MIPH)

Ø  Superficial Benign tumors excision

Ø  Pilonidal sinus excision

Ø  Sebaceous cyst removal

Ø  Debridement

Ø  I & D

Gynaecology Procedures: 

Ø  Diagnostics Laparoscopy

Ø  Diagnostics Hysteroscopy

Ø  Operative Hysteroscopy

Ø  Colposcopy

Ø  LETZ (large loop excision of the transformation zone) / LEEP (Loop Electrosurgical Excision Procedure)

Ø  IVF Procedures(oocyte pickup)

Ø  Fresh Embryo Transfer

Ø  Frozen Embryo Transfer

Ø  Trans vaginal Ovarian Cyst Aspiration

Ø  Proximal Tubal Catheterization

Ø  Cyrocoti of cervix

Ø  IUDI – Intra Uterine Device Inserts

Ø  Laparoscopic Tubal Sterilization

Ø  MPT(surgical)

Ø  D&C and D&E

Opthamological Procedure: 

  • Cataract surgery
  • Vitro retinal surgery
  • Squint surgery
  • Glaucoma Surgery
  • LASIK Surgery
  • EUA for pediatric patients
  • Occuloplasty
  • Penetrating globe injury surgery
  • DCR surgery

Plastic Surgery:

  • Skin grafting
  • Liposuction
  • Scar revision
  • Rhinoplasty
  • Breast Augmentation/ Reduction
  • Face Lift
  • Eyelid surgery

In ambulatory centre patients are discharged if they are:

  • Hemodynamically stable
  • Normal physical activity
  • Awake and well oriented to time/place/person
  • Regained all reflexes
  • Minimal or no pain
  • No signs of nausea and vomiting
  • Able to void

So, consider daycare surgery as the default for all elective surgery – Ask why not? - Rather than why?