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Surgical Factors considered when deciding whether or not a surgery should be a day case:

• The procedure should have a low complication rate, unlikely to cause loss of independence or incontinence.
• There should be minimal blood loss expected.
• Postoperative pain should be controllable with oral analgesia ± regional anesthesia techniques. Central neuraxial blockade and a range
4
of regional anesthetic techniques, including brachial plexus and paravertebral blocks, can be used effectively for day surgery.
• The patient should be able to rapidly resume normal functions such as oral nutrition and safe mobilization (although full mobilization is not
5
always essential.)
• The length of the actual procedure (cut to close time) should be expected to be two hours or less. Although this expectation is beginning to
change, this will remain one of our factors.

Process:

Who is involved: Surgeon; Anesthesiologist

When Is Decision made: During final surgical visit
During Preoperative assessment

How is Decision made: Based on his experience with the surgical procedure, the surgeon will make a decision regarding whether the surgery
is a day case. The anesthesiologist will have an opportunity to confirm during the pre-op assessment period. If the
anesthesiologist has any concerns about the procedure as a day case, he/she will contact the surgeon to address.

Criterion 2: Medical

Overview:

The medical criterion includes health-related factors specific to the patient such as age, BMI, and co-morbidities. This is arguably the most important
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criterion. Managing it is also a complex multidisciplinary process because there are very few absolute contraindications to day case surgery. For
example, patients with high BMIs, were previously rarely considered for day surgery.

4 Verma R, Alladi R, Jackson I, et al. Day case and short stay surgery: 2, Anaesthesia, 2011; 66 : pages 417-434.
5 Ibid, pp 417-434.
6 Daniel J Quemby MBBS(Hons) BSc(Hons) BSc Med Sci, MIBiol MRCS FRCA, Mary E Stocker MA (Oxon) MBChB FRCA , “Day surgery development and practice: key factors for a
successful pathway”, Contin Educ Anaesth Crit Care Pain, Dec 5, 2013.
The Shoulder and Upper Limb Unit