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Factors influencing selection for a day-case or 23-h stay procedure in transanal endoscopic microsurgery
S J Ford1, J M D Wheeler, N R Borley
1Department of General Surgery, Cheltenham General Hospital, Cheltenham, UK. samuelford@hotmail.co.uk
Background:
Transanal endoscopic microsurgery (TEMS) is an alternative to radical resection of the rectum for benign lesions and early rectal cancer. This study aimed to identify whether day-case TEMS is safe and which factors dictate patient suitability and length of stay (LOS).
Methods:
Details of patients undergoing TEMS resection were retrieved from a tertiary referral prospective database.
Results:
Of 96 patients, 46 (48 per cent) were day cases, 24 (25 per cent) had a 23-h stay and 26 (27 per cent) were inpatients. The frequency of day-case surgery increased significantly over the study interval (P = 0.050). Distance of the lesion from the anorectal junction, malignant potential and travel distance had no bearing on LOS. Older age (P = 0.004) and duration of surgery (P = 0.002) correlated significantly with increased LOS. Lesions covering one quadrant involved a significantly shorter stay than those covering two or more quadrants (P = 0.002). Maximum diameter (mean 5.7 cm) was strongly related to LOS (P = 0.009). Day-case and 23-h stay patients had a significantly higher proportion of lower-risk lesions (P = 0.001).
Conclusion:
High-volume day-case TEMS appears safe, even when long travel distances are involved. With advances in practice and procedural safety, traditional risk factors may not be as important as currently thought.
