Day case and short stay surgery: 2

1 Day surgery is a continually evolving speciality performed in a range of ways across different units. 2 In recent years, the complexity of procedures has increased with a wider range of patients now considered suitable for day surgery. 3 Effective pre-operative preparation and protocol-driven, nurse-led discharge are fundamental to safe and effective day and short stay surgery. 4 Fitness for a procedure should relate to the patient’s health as determined at pre-operative preparation and not limited by arbitrary limits such as ASA status, age or body mass index. 5 Patients presenting with acute conditions requiring urgent surgery can be efficiently and effectively treated as day cases via a semi-elective pathway. 6 Central neuraxial blockade and a range of regional anaesthetic techniques, including brachial plexus and paravertebral blocks, can be used effectively for day surgery. 7 Each anaesthetist should develop techniques that permit the patient to undergo the surgical procedure with minimum stress and maximum comfort, and optimise his ⁄ her chance of early discharge. 8 Every day surgery unit must have a Clinical Lead with specific interest in day surgery and whose remit includes the development of local policies, guidelines and clinical governance. 9 Good quality advice leaflets, assessment forms and protocols are in use in many centres and are available to other units. 10 Effective audit is an essential component of good care in all aspects of day and short stay surgery. 11 Enhanced recovery is based on established day surgery principles and is aimed at improving the quality of recovery after inpatient surgery such that the patient is well enough to go home earlier and healthier. The definition of day surgery in the UK and Ireland is clear: the patient must be admitted and discharged on the same day, with day surgery as the intended management. Although still counted as inpatient treatment (except in the US), 23-h and short stay surgery apply the same principles of care outlined in this document and can improve the quality of patient care whilst reducing length of stay. Since the previous guideline was published in 2005, the complexity of procedures has increased with a wider range of patients now considered suitable for day surgery. Despite these advances, the overall rates of day surgery remain variable across the UK. Whereas the target of 75% of elective surgery to be performed as day cases from the NHS plan remains [1], the true picture is difficult to determine, since the only nationally reported data are limited to 25 procedures [2]. Ten years on, the advancement of minimally invasive Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation. Anaesthesia, 2011, 66, pages 417–434 doi:10.1111/j.1365-2044.2011.06651.x .....................................................................................................................................................................................................................