Day Care Surgery

Question 1

What is Daycare surgery?

Answer 1

Admitted+Discharged within 12 hours

Question 2

What is Overnight stay?

Answer 2

23 hour admission+Early morning discharge

Question 3

What is Short stay surgery?

Answer 3

Admission upto 72 hours

Question 4

Eligibility based on ASA grade

Answer 4

1 & 2: Stand alone daycare unit
3: Integrated daycare surgery centre

Question 5

Selection criteria for Daycare surgery

Answer 5

1. Medical
2. Social
3. Surgical

Question 6

Medical reasons for selection in Daycare surgery

Answer 6

1. Physiological > Chronological age
2. ASA status > 2: Careful review (involve anaesthetist)
3. BMI <40: Surgery not C/I

Question 7

Social reasons for selection in Daycare surgery

Answer 7

1. Availability of responsible care giver for 1st 24 hours
2. Suitable home conditions
3. Ability to contact hospital in case of emergency

Question 8

Surgical reason for selection in Daycare surgery

Answer 8

Operations up to 2 hours: Recognised as day care surgeries

Question 9

Other criteria for Daycare surgery

Answer 9

1. BP <180/110 mmHg
2. In a diabetic: HbA1c <8.5 (Skip morning dose of OHA
3. Eligible BMI (kg/m2):
   > <40: Surface procedures
   > <30: Laparoscopic procedures
4. Well controlled case of epilepsy

Question 10

Anaesthesia used in Daycare surgery

Answer 10

Total intravenous anaesthesia: Propofol (Dec in post op nausea+vomiting)

Question 11

Analgesia used in Daycare surgery

Answer 11

Post op analgesic: Infiltration with Bupivacaine (Long acting, most cardiotoxic)

Question 12

M/C complication post daycare surgery

Answer 12

Nausea+Vomiting (Assessed using Apfel score)

Question 13

M/C complication requiring readmission

Answer 13

Haemorrhage

Question 14

What are the vital signs criteria for discharge?

Answer 14

Vital signs must be stable for at least one hour and the patient must be oriented to time, place, and person.

Question 15

What is required for pain management before discharge?

Answer 15

The patient must have adequate pain control with oral analgesia and understand how to use it.

Question 16

What fluid intake criteria must be met for discharge?

Answer 16

The patient must have taken oral fluids and, if appropriate, passed urine.

Question 17

What is the wound condition required for discharge?

Answer 17

There should be minimal wound discharge or bleeding.

Question 18

What mobility and support criteria must be met for discharge?

Answer 18

The patient must be able to dress and walk where appropriate, and have a responsible adult to take them home.

Question 19

ERAS protocol

Answer 19

Enhanced Recovery After Surgery

Question 20

Preoperative measures in ERAS Protocol

Answer 20

1. Counselling
2. Avoid mechanical bowel preparation (D/t fluid+electrolyte imbalance)
3. Permitted to take prior to surgery:
   > Solids up to 6 hours
   > Clear carb rich liquids up to 2 hours (Carb loading)

Question 21

Intraop measures in ERAS Protocol

Answer 21

1. Surgical approach: Minimally invasive
2. Bupivacaine infiltration
3. Keep patient warm
4. Nausea+vomiting preparation (At least 2 classes of medication)

Question 22

Post-op measures in ERAS protocol

Answer 22

1. Use NSAIDs, avoid opioids
2. Within 24 hours:
   > Discontinue IV fluids
   > Start with liquids f/b regular diet
   > Ambulate
3. Avoid drains/Plan early removal