Day case surgery: geographical variation, trends and readmission rates.

Abstract

Data from the Oxford Record Linkage Study were analysed to determine the amount of work undertaken in day case surgery for 12 surgical conditions in five districts in the Oxford Region during the years 1976 to 1985. Record linkage was used to study readmission rates, comparing day surgery with inpatient care. The use of day surgery gradually increased in some conditions (eg, termination of pregnancy, female sterilisation) but did not increase from a fairly low base for others (eg, inguinal hernia repair, operations on varicose veins and haemorrhoids). There were striking differences between the districts in the use ofday case care. For example, the use ofday case care as a percentage of all hospital admissions for termination of pregnancy varied from 1% in one district to 24% in another; that for dilatation and curettage varied from 1% to 43%; and that for female sterilisation varied from < 1% to 35%. Emergency readmission rates after day surgery were similar to those following inpatient treatment. We conclude that the use of day surgery for some conditions judged suitable for day care is still low and, even within one region, variation in the use ofday surgery is considerable. The reasons for continued reluctance in some places to undertake more day surgery merit investigation.

Transitions in laparoscopic cholecystectomy

“…Another major obstacle to the implementation of ambulatory surgery has been ascribed to resistance from the surgeon [4]. Delay in the management of postoperative complications is a chief concern of most surgeons [15], but the belief that this is a problem has not been substantiated by any studies in which the patients were appropriately selected.…”

Return Hospital Visits and Hospital Readmissions After Ambulatory Surgery

“…However, because their study identified return visits occurring only in the same hospital, readmissions may have been missed if patients went to another hospital. Henderson et al, 10 using record linkage, reported emergency readmission rates within 28 days after day surgery; however, they did not determine whether the readmissions were related to the prior ambulatory surgery. 10 There are no available published results on complication-specific readmission rates in a large study population within an extended observation period after ambulatory surgery.…”

“…None of the above studies, however, reported what percentage of patients needed hospital admission. Henderson et al 10 identified emergency readmission rates of 0% to 2.3% within 28 days after ambulatory surgery. The frequency of readmissions depended on the type of surgery; however, the percentage of readmissions related to the previous ambulatory surgery was not specified.…”

International variations in availability and diffusion of alternatives to in-patient care in Europe: the case of day surgery

“…Previous research has revealed that day surgery is not always a substitute for inpatient care; it may be supplementary [6,7]. According to Haworth and Balarajan [6], day surgery may only be a substitute for inpatient care where the population is adequately provided, or even over-provided, with inpatient care.…”

“…On the physician's side there may be problems through lack of experience with new techniques, or doubts concerning the safety of a procedure. For physicians, personal preferences such as a tendency to adopt innovations may also play a part, as may local customs [4][5][6][7]. Second, hospital characteristics, such as the organization of hospital care, the number of hospital beds, the size of the hospital, may play a part.…”