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However, it has now been found that for some procedures, some patients with a high BMI actually benefit from day surgery management with its
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short-acting anaesthetics and early mobilization.
The key medical question to consider for day surgery is: Would the management or outcome be improved by post-operative hospitalization? If not,
the patient should undergo treatment on a day basis.

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• Age: There is no upper age limit. Patient selection is based on overall physiological status, not age. The patient should be
mentallysound, and reasonably independent and active.

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• BMI: Obesity is not an absolute contra-indication for day care. Patients with a BMI ≥30 will undergo an assessment by the
anesthesiologist.

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• ASA Grade: Patients should be ASA grade 1 or 2 or selected ASA grade 3. Patients with conditions not suitable for day surgery
include, those with severe heart disease (e.g. ongoing angina, or recent MI with stents), diabetes with vascular
complications, or stage 3 COPD.

• Co-morbidities: Co-morbidities must be controlled. These include diabetes, cardiac issues, epilepsy, asthma, & sleep apnea. Research
shows that stable patients with conditions such as diabetes, asthma or epilepsy may be better managed as day cases
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due to minimal disruption to their routine.

Due to the high prevalence of diabetes and cardiac conditions in the UAE, specific guidelines are included to ascertain whether day case surgery
is possible and beneficial to the patient.

** Diabetes: Hb1AC should be less than 8%
** Cardiac Conditions: Mild angina can be managed or a previous uncomplicated MI, having occurred more than 6 months previously.

Patients with conditions such as uncontrolled diabetes, previous significant cardiac pathologies, or on dialysis will automatically be placed on an
inpatient pathway.

7 Davies KE, Houghton K, Montgomery JE. Obesity and day-case surgery. Anaesthesia 2001; 56: 1112–5.
8 Day Surgery as the new paradigm of surgery: best practices and recommendations; Danish Regions 2013: http://www.daysafe.eu/wp-content/uploads/2013/11/Policy-Brief.pdf.
9 Nationwide use and outcomes of ambulatory surgery in morbidly obese patients in the United States. J Clin Anesth. 2014 May;26(3):191-8.
10 Castoro C, Bertinato L, Baccaglini U et al, “Policy brief, day surgery: making it happen.” (2007) European Observatory on Health Systems and Policies.
11 Verma R, Alladi R, Jackson I, et al. Day case and short stay surgery: 2, Anaesthesia, 2011; 66 : pages 417-434.
The Shoulder and Upper Limb Unit