Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons

Abstract

BACKGROUND Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case. This could have significant benefits for patients and the health service. However there are theoretical concerns about post-operative complications and patient satisfaction due to pain. AIM To scope the current practice of foot and ankle surgeons on day-case surgery for major foot and ankle procedures in the United Kingdom (UK). METHODS An online survey (19 questions) was sent to UK foot and ankle surgeons via the British Orthopaedic Foot & Ankle Society membership list in August 2021. Major foot and ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge, with day surgery as the intended treatment pathway. RESULTS 132 people responded to the survey invitation with 80% working in Acute NHS Trusts. Currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures. 78% felt that there was scope to perform more procedures as day-case at their centre. Post-operative pain (34%) and patient satisfaction (10%) was not highly measured within their centres. Lack of adequate physiotherapy input pre/post-operatively (23%) and lack of out of hours support (21%) were the top perceived barriers to performing more major foot and ankle procedures as day-case. CONCLUSION There is consensus among UK surgeons to do more major foot/ankle procedures as day-case. Out of hours support and physiotherapy input pre/ post-op were perceived as the main barriers. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. There is a need for nationally agreed protocols to optimise the delivery of and measurement of outcomes in this type of surgery. At a local level, the provision of physiotherapy and out of hours support should be explored at sites where this is a perceived barrier.

Perioperative management for elderly patients undergoing day surgery: evidence-based practice for nursing care and day surgery

“…In this process, the time and channels for elderly patients and their families to receive information related to daytime surgery are insufficient, which can easily lead to many feelings of uncertainty and conflict about disease treatment, hospitalization environment, and medical process after admission. According to the evidence content of perioperative management of elderly patients undergoing day surgery, it combines preoperative health education and second confirmation of operation time of patients moving forward, prompting the admission time of patients in advance, improving the preoperative examination, estimating the length of stay in hospital, and suggesting reliable family members to accompany (31,32). The results of this study show that after evidencebased practice, the implementation of indicators 1, 2, and 4 has been significantly improved.…”