Day surgery, variations in routines and practices a questionnaire survey

Day surgery is expanding however little is known about every day practice and routines.

A web-based questionnaire including 34 questions with fixed multiple choice responses around routine and practice for the perioperative handling of patients scheduled for day case surgery was send to 100 hospitals.

There was an overall response rate of 70%. Most centres had a dedicated day surgery unit (87%). Preoperative assessment routines, when, how and by whom varied. Patient self-assessment questionnaires were common practice (87%). Upper age limit was uncommon (10%), lower age limit common (77%), and fixed high body mass index-limitation showed a mixed pattern, mean 40%. Postoperative nauseas and vomiting-risk stratification varied mean 46%. Anxiolytic premedication was uncommon. Administration of oral analgesics varied, mean 70%; paracetamol (94%), NSAIDs (80%) and opioid (28%). Preferred general anaesthesia technique varied considerable. Laryngeal mask airway was consistently used. Management of pain while in hospital was consistently performed. A majority centres provided take-home analgesics "tablet-package" (69%) or as prescription (80%). Strong opioids to be taken at home were given or prescribed by 59% of units. Written information about the postoperative care was common practice (90%), written instruction about management of pain was less frequently provided (69%). Most hospitals (93%) had standardised discharge criteria, including demand of an escort (75%) and not being alone first postoperative night (81%).

We found that regime for day surgical anaesthesia practice varied between as well as within countries. There is obvious room for further research on how to achieve safe and cost-effective logistics and practice for day case surgery.