Paediatric day surgery: revisiting the University Hospital of the West Indies experience
M Scarlett1, A Crawford-Sykes, M Thomas
1Section of Anaesthesia and Intensive Care, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica, West Indies. mdscarl@yahoo.com
Insights
Paediatric day surgery (PDS) offers a cost-effective solution with reduced wait times and psychological distress for children. This study highlights the safety and increasing prevalence of PDS at UHWI, recommending service expansion.
Area of Science:
- Pediatric Surgery
- Health Economics
- Surgical Outcomes
Background:
- Day surgery is a cost-effective alternative to inpatient procedures, particularly beneficial for developing countries with limited health budgets.
- Paediatric day surgery (PDS) at the University Hospital of the West Indies (UHWI) has a long-standing history of over 40 years.
- PDS offers significant benefits, including reduced psychological trauma for children and parents, higher patient turnover, and shorter waiting lists.
Purpose of the Study:
- To review the trends and outcomes of paediatric general surgical (PGS) procedures performed as day surgery at UHWI.
- To assess the safety, complication rates, and admission rates associated with PDS.
- To evaluate the feasibility and recommend further expansion of PDS services.
Main Methods:
- A retrospective review of 975 paediatric general surgical procedures performed on 963 patients at UHWI between January 2001 and December 2004.
- Data collection included patient demographics, surgical procedures, length of stay, readmission rates, and complications.
- Analysis of PDS trends from 1984 to the study period.
Main Results:
- Paediatric day surgery constituted 74.6% (727 procedures) of all PGS procedures during the study period.
- The most common procedures were inguinal hernia repair (43.2%), umbilical/epigastric herniorrhaphy (20.1%), and circumcision (13.3%).
- Unplanned admissions occurred in 2.1% of cases, with no mortality. 90% of patients were discharged within 2-4 hours post-surgery.
Conclusions:
- Paediatric day surgery at UHWI has shown a positive trend, increasing from 60% in 1984 to 75% in the study period.
- PDS procedures were performed safely with a low complication rate, demonstrating its efficacy.
- Further expansion of PDS services is recommended to maximize benefits for patients and the healthcare system.
Abstract:
Day surgery is cheaper and allows for less time delay. In developing countries with limited health budgets, these factors lead to higher patient turnover and shortened waiting lists. The decreased psychological trauma for both parents and children is significant. Paediatric day surgery (PDS) has been done at the University Hospital of the West Indies (UHWI) for over 40 years. A total of 975 paediatric general surgical (PGS) procedures were performed on 963 patients at the UHWI during the four-year period, January 2001 to December 2004. Paediatric day surgery numbered 727 (74.6%). Males outnumbered females 2:1, the age range was 2 weeks to 15 years, with an average age of 4 years. Ninety-seven (13.3%) of these patients were less than six months old, including eight neonates. One hundred and forty-five (20%) had more than one surgical procedure. Most children, 314 (43.2%) had inguinal hernia repair. Umbilical/supra-umbilical/epigastric herniorrhaphy (20.1%) was the next most frequently performed procedure, followed by circumcision (13.3%) and orchidopexy (5.9%). Ninety per cent of these patients were discharged home within 2-4 hours after surgery. Unplanned admissions were 2.1% of the cases. These were due to age, unplanned extensive surgical procedure, drug reaction and fever There was no mortality in this study population. This review showed that the number of PDS has increased from 60% in 1984 to 75%. These procedures were performed safely with a low complication rate. Further expansion of the service is recommended.
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