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DAY CARE SURGERY DR V P Shanmuga Sundaram  MS., FICS,. Advanced Laparoscopic Surgeon K.G.Hospital.

DAY CARE SURGERY DR V P Shanmuga Sundaram  MS., FICS,. Advanced Laparoscopic Surgeon K.G.Hospital. History 1. Nicholls – 1909 – BMJ-9000 children as day care Surgery 2. 1985 – Royal college of surgeons of England published “Guidelines for day care surgery ”.

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DAY CARE SURGERY DR V P Shanmuga Sundaram  MS., FICS,. Advanced Laparoscopic Surgeon K.G.Hospital.

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  1. DAY CARE SURGERY • DR V P Shanmuga Sundaram  MS., FICS,. • Advanced Laparoscopic Surgeon • K.G.Hospital. • History • 1.Nicholls – 1909 – BMJ-9000 children as day care Surgery • 2.1985 – Royal college of surgeons of England • published “Guidelines for day care surgery ”. • 3.1989 – British Assn of day surgery was formed .

  2. DEFINITION : A surgical day case is a patient who is admitted for investigation or operation on a planned non – resident basis and who non theless requires facilities for recovery . -Royal college of surgeons.

  3. SELECTION CRITERIA 1.   Generally fit & healthy . ( ASA 1 & 2 ) 2.   Should be older than 6 months. No age upper limit Normal .airway,No recent URTI 3.   operations lasting less than 1 hour only. 4.   Less significant post op pain or bleeding . 5.   Prolonged immobility

  4. To be escorted by a responsible adult • 7.  Patients should live within 1 hour’s travelling • distance from the hospital • 8. Indoor bathroom. • Day care surgery does not include upper lower GI endoscopies flexible cystoscopy ,minor superficial surgery which require L.A.

  5. ADVANTAGES : 1. Pre booked dates 2. No chance of cancellation 3. Easy domestic arrangements 4. Earlier mobilization 5. Early return to normal environment 6. Reduced risk of cross infection 7. Less psychological disturbance. 8.Expenses are very less .

  6. CO- EXISTING DISEASE : Status asthmaticus Status epilepticus Well controlled DM DRIVING : Patients should not drive for at least 24hour post op.,because of residual effects of anaesthesia . PRE OP .INVESTIGATION : CBC, BL. Sugar, ECG, Chest X- Ray.

  7. SPECIFIC BLOCKS : Field block – Example .for Hernia . Spinal - (D) after 6 hours . Epidural - Less suitable . Brachial plexus blocks . DISCHARGE DRUGS : Oral - analgesics atleast for 2 days

  8. DAY CARE SURGERIES • Groin / abdominal hernia repair • Excision breast lump • Minor anal surgery ( Fissure) • Varicose vein surgery • Circumcision • Hydrocele • Laparoscopic sterilization • Pilonidal sinus

  9. Lap Cholecystectomy • Lap Appendicectomy • Submandibular gland excision • Thyroid adenoma • Superficial parotidectomy • Breast mass excision, Mastectomy • Haemorrhoidectomy

  10. (D) CRITERIA : 1.   Stable vital signs 2.   Fully awake & oriented 3.   Able to eat & drink 4.   Passed urine after spinal 5.   Ambulant 6.   Pain & nausea well controlled

  11. ORGANISATION : (D) SUMMARY 1.   Remove I.V cannula 2.   Check the wound 3.   Written & verbal (D) information 4.   Drugs 5.   Date for S.R. 6.   Letter to GP 7.   Contact telephone No. 8.   Collected by responsible adult

  12. REASON FOR OVERNIGHT ADMISSION : • Unexpectedly more extensive surgery • Uncontrolled pain or PONV • Bleeding , perforated viscus • 4. Unexpected surgical or anaesthetic complications.

  13. EXTENED DAY SURGERY : OR 23 HOUR SURGERY Laparoscopic Cholecystectomies , Thyroidectomies or mastectomies may be admitted in a ward in which patients are admitted on the day of surgery & discharged the follow up day. Benefit is that the efficiency of day surgery is opened up to a wider range of cases.

  14. HOSPITAL HOTELS : & HOSPITAL AT HOME   Separate building adjacent to the hospital providing accommodation for patients who are mobile & self caring but who require overnight stay in the hospital, for social reasons. There will be auxiliary nurses or paramedics to act as responsible adult required by patients.  Physiotherapists , nurses & other professionals could visit the patients home to provide care.

  15. KEY POINTS FOR DAY CASE SURGERY •    “The future growth” • recognizing its benefits. • appropriate patient selection • extended day surgery - one overnight stay . • “DAY HOSPITAL” • The efficiency - clinical director - surgeon - assumes overall responsibility

  16. ECONOMIC IMPACT ON NATIONAL ECONOMIC SCENARIO ECONOMIC SOLUTIONS GALL STONE - GAS TROUBLE APPENDIX - 10,000 + 8000 18,000 DAY CARE 9000 NATIONAL LOSS 9000

  17. DAY CARE SURGERY DR V P Shanmuga Sundaram  MS., FICS,. Advanced Laparoscopic Surgeon K.G.Hospital. Thank You

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