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Feasibility of day case varicose vein surgery in a district general hospital
Insights
Day case varicose vein surgery is feasible and cost-effective, but pre-operative patient selection is advised to minimize overnight admissions, especially for older patients or those with bilateral varicose veins.
Area of Science:
- Vascular Surgery
- Ambulatory Surgery
- Health Services Research
Background:
- Day case surgery offers potential for reduced inpatient bed utilization.
- Varicose vein surgery is a suitable candidate for evaluating day surgery service efficiency.
Purpose of the Study:
- To assess the feasibility of performing varicose vein surgery as a day case for all patients.
- To identify predictors of hospital admission following day case varicose vein surgery.
Main Methods:
- A retrospective review of 542 patients undergoing varicose vein surgery between July 1995 and July 1998.
- Standard surgical technique included sapheno-femoral ligation, below-knee stripping, and avulsions.
- Patients received standard post-operative wound care and a six-week follow-up.
Main Results:
- 72% of patients were discharged on the day of surgery.
- 25% required a one-night stay, primarily due to anesthetic complications or patient preference.
- Admission was significantly associated with patient age, bilateral varicose veins, and spinal anesthesia.
Conclusions:
- Day case varicose vein surgery is safe, acceptable, and cost-effective.
- A significant proportion of patients require overnight admission when all-comers are treated.
- Pre-operative patient selection is recommended to optimize day case outcomes.
Background:
Day case surgery may reduce inpatient bed requirements, and varicose surgery may be an ideal operation to test the functioning of a day surgery service.
Aims:
To evaluate retrospectively the feasibility of day case varicose vein surgery in all-comers, and to identify the risk factors for admission.
Methods:
Over a three-year period from July 1995 to July 1998, all patients requiring varicose vein surgery had their procedure performed as a day case. A standard technique of sapheno-femoral ligation with below-knee stripping of the long saphenous vein and multiple stab avulsions of varicosities was performed. All limbs were dressed with wool in crepe bandage and were reviewed post-operatively at six weeks.
Results:
Five hundred and forty two patients underwent varicose vein surgery, of whom 26% had bilateral varicose veins, 88% had primary varicose veins and 22% had recurrent disease. The procedure was performed under general anaesthesia in 86% of cases and under spinal anaesthesia in the rest. There was no peri-operative mortality. Ten patients (1.9%) developed post-operative complications. Seventy two per cent of patients were discharged on the day of surgery, a further 25% required admission for one night due to minor anaesthetic complications and patient preference. Four per cent required admission for more than 24 hours. The need for overnight admission was associated with the age of the patients (p < 0.0001), bilateral varicose vein surgery (p < 0.005) and the use of spinal anaesthesia (p < 0.01).
Conclusion:
Although varicose vein surgery is safe, acceptable and cost-effective as a day case procedure, if attempted in all-comers, overnight admission will be required in a significant proportion. Pre-operative selection is advised.