Problems in day care surgery

In-patient admission represents a failure of a day care service. The hospital records of 105 patients transferred from the day ward to the in-patient wards were studied retrospectively. Of 2,039 patients treated in the day care ward, 105 (5%) required in-patient admission over a 12 month period. Of these 105 admissions, 17% did not fulfil the criteria for day care patients, 46% had surgical problems, and 35% anaesthetic-associated problems. The in-patient admission rate could be reduced by improved out-patient selection of cases, use of a separate day care theatre, increased use of local anaesthetic techniques, reduction in the use of parenteral opioids, the use of simple oral analgesics or non-steroidal anti-inflammatory agents as pre-emptive analgesia and a wider use of propofol as an induction agent which provides superior recovery from anaesthesia.