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Ambulatory paediatric surgery. The development of a day-care surgical centre
H Rode1, A J Millar, D McCormack
1Department of Paediatric Surgery, University of Cape Town.
Insights
Establishing a day-case surgical unit significantly improved surgical care efficiency and patient outcomes. This model demonstrates effective resource utilization and minimal complications for pediatric ambulatory surgery.
Area of Science:
- Pediatric Surgery
- Healthcare Management
- Surgical Outcomes
Background:
- Ambulatory surgery is a crucial aspect of modern surgical care delivery.
- A dedicated day-case surgical unit was established at Red Cross War Memorial Children's Hospital in 1987.
- This review covers a 6-year operational experience from 1987 to 1992.
Purpose of the Study:
- To evaluate the experience and outcomes of a pediatric day-case surgical unit.
- To assess the nature and volume of procedures, pre-operative preparation, facility utilization, and post-operative care.
- To identify complications and patient/parent acceptance of the ambulatory surgery model.
Main Methods:
- Retrospective review of 16,538 pediatric patients undergoing surgery between 1987 and 1992.
- Analysis of surgical procedures across nine disciplines, pre-operative assessment protocols, and operating time utilization.
- Evaluation of post-operative stay, complication rates, and patient/parent feedback.
Main Results:
- Over 16,500 pediatric patients (mean age 3 years) were treated.
- Effective pre-operative preparation reduced same-day cancellations to <6% and achieved 90% operating time utilization.
- Procedures were predominantly short (<30 min), with a 6-hour average stay, minimal complications, and excellent acceptance; only 16 patients required overnight admission.
Conclusions:
- A well-managed day-stay surgical service is practical and efficient for pediatric care.
- The model demonstrates optimal utilization of resources, including nursing staff.
- Expansion of appropriate day-stay surgical facilities is recommended for broader implementation.
Abstract:
Ambulatory surgery has become an important component in the provision of surgical care. In 1987 a day-case surgical unit was established at Red Cross War Memorial Children's Hospital, Cape Town. Experience over a 6-year period (1987-1992) is reviewed in relation to the nature and total number of surgical procedures, pre-operative preparation, daily utilisation of the facility, postoperative care and complications. During this period 16,538 patients (mean age 3 years) were operated on in the unit. Nine surgical disciplines participated. Pre-operative assessment and preparation reduced the rate of cancellations on the day of surgery to less than 6%, with a 90% effective use of schedules operating time. Scarce nursing resources were also maximally utilised. Most procedures took less than 30 minutes and only 0.8% exceeded 1 hour. The average ward stay was 6 hours. No major complications were encountered and acceptance by patients and parents was excellent. Only 16 children who were not scheduled to do so needed to stay in hospital overnight. Recommendations to establish and improve day-stay surgical services are presented. It is concluded that a practical, efficient service can be established and that the authorities should be encouraged to expand appropriate facilities.