The NHS Plan predicts that 75% of all elective operations will be carried out as day cases.w1 According to the British Association of Day Surgery, patients overwhelmingly endorse day surgery and it provides timely treatment, less risk of cancellation, lower incidence of hospital acquired infections, and an earlier return to normal activities.w2 We looked at rates of day surgery, using the Audit Commission's collection of 25 operationsw3 by using hospital episode statistics between 1996-7 and 2003-4.
The bottom line
Day surgery rates have continued to rise steadily over the past eight years
Wide variation between trusts still exists
Day case rates have decreased for some procedures
We looked at trends over time and compared rates across acute trusts. Overall, the proportion of procedures carried out as day surgery increased from 55.7% to 67.2% over the period. Although most individual procedures showed an increase in day surgery rates, arthroscopy, laparoscopy, myringotomy, and transurethral resection of bladder tumour all had lower rates in 2003-4 than in 1996-7. The procedure that showed the greatest percentage decline in total admissions was termination of pregnancy, which dropped 44.4% from 68 102 in 1996-7 to 37 887 in 2003-4. This may reflect an increasing number of medical terminations. Cataract operations showed the greatest increase in total admissions, rising 94.8% from 148 492 in 1996 to 289 252 in 2003-4. Day surgery rates varied considerably between the acute non-specialist trusts, ranging from 40.2% to 82.7%, with only 12% of trusts carrying out 75% or more of the Audit Commission's collection of procedures as day cases.
The 2005 Healthcare Commission report on day surgery confirmed that day surgery units are not being used to their maximum capacity,w4 although both rates and numbers increased steadily between 1996-7 and 2003-4. Performance varies widely between trusts; some of this variation might be explained by inconsistent coding, particularly if day surgery cases are miscoded as inpatients. Differences in case mix between hospitals is another possible explanation. Our conclusions, however, are much the same as those of the Healthcare Commission, that day surgery rates are continuing to improve, yet the range of performance between NHS trusts remains wide, leaving considerable scope for the poorer performers to improve.
Table 1.
Trends in day surgery admissions for the 10 most common procedures in the Audit Commission's collection of day surgery procedures*
|
Day cases (%) (No of day cases/No of total admissions)
|
% change in total admissions
|
||
|---|---|---|---|
| Procedure | 1996-7 | 2003-4 | |
| Arthroscopy | 65.1 (46 536/71 454) | 62.0 (65 059/103 303) | 44.6 |
| Carpal tunnel decompression | 81.8 (21 373/26 133) | 90.0 (40 620/45 139) | 72.7 |
| Cataract operations | 59.2 (87 881/148 492) | 93.2 (269 498/289 252) | 94.8 |
| Dilatation and curettage/hysteroscopy | 72.6 (57 930/79 775) | 78.5 (55 058/70 154) | −12.1 |
| Inguinal hernia repair | 36.3 (23 381/64 353) | 47.8 (34 876/72 898) | 13.3 |
| Laparoscopic cholecystectomy | 0.83 (160/19 193) | 4.4 (1 567/35 410) | 84.5 |
| Laparoscopy | 72.1 (72 174/100 143) | 70.0 (60 326/86 168) | −14.0 |
| Termination of pregnancy | 89.6 (61 026/68 102) | 93.6 (35 462/37 887) | −44.4 |
| Tonsillectomy | 3.1 (1 921/62 390) | 8.0 (3 746/47 007) | −24.7 |
| Varicose vein stripping or ligation | 45.6 (19 855/43 581) | 55.3 (21 715/39 239) | −10.0 |
χ2 test for trend; P value <0.001 for all procedures examined.
Table 2.
Trends in percentage of day surgery admissions for procedures in the Audit Commission's collection of 25 procedures
| Year | No of inpatients | No of day surgery cases | % day surgery cases* |
|---|---|---|---|
| 1996-7 | 413 309 | 519 128 | 55.7 |
| 1997-8 | 370 295 | 504 213 | 57.7 |
| 1998-9 | 408 910 | 618 759 | 60.2 |
| 1999-2000 | 373 413 | 617 992 | 62.3 |
| 2000-1 | 353 824 | 636 513 | 64.3 |
| 2001-2 | 337 493 | 639 668 | 65.5 |
| 2002-3 | 349 826 | 684 854 | 66.2 |
| 2003-4 | 346 332 | 708 236 | 67.2 |
χ2 test for trend; P<0.001
The basic figures
The day surgery rate for all procedures combined within the collection of 25 procedures rose from 55.7% in 1996 to 67.2% in 2003
Day surgery rates for arthroscopy, laparoscopy, myringotomy with or without grommets, and transurethral resection of bladder tumour decreased significantly; for all other procedures, the day surgery to inpatient admission ratio increased significantly
The procedure that showed the greatest percentage decline in total admissions was termination of pregnancy, which dropped 44.4% (from 68 102 in 1996/7 to 37 887 in 2003/4); cataract operations showed the greatest increase in total admissions (including day surgery), rising 94.8% from 148 492 in 1996 to 289 252 in 2003
The percentage of day surgery cases varied considerably between the acute NHS trusts, ranging from 40.2% at University College London Hospital NHS Trust to 82.7% at Kingston Hospital NHS Trust
Only 12% of trusts carry out 75% or more of the Audit Commission's collection of procedures as day surgery cases
Supplementary Material
This month's Dr Foster's case notes were compiled by Paul Aylin, Susan Williams, Brian Jarman, and Alex Bottle at the Dr Foster Unit at Imperial College. Dr Foster is an independent research and publishing organisation created to examine measures of clinical performance.
References, information on data processing, and additional tables and figures are on bmj.com
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