CANDIDATES FOR ONE DAY SURGERY reoperations

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Aim	To identify inpatient stays that could be performed as one day surgery
Definition of the indicator	Proportion of candidates for one day surgery among elective surgery inpatient stays.
Cases	A stay is considered as candidate for one day surgery if following conditions are fulfilled : - at least one surgical intervention feasible in one day surgery, involving no more than one organ; - no intervention requiring a length of stay greater than 24 hours; - no affection requiring a length of stay greater than 24 hours; - no significant complication or reopening of a surgical site; - patient neither transferred, nor died; - length of stay equal or less than 4 days (admission and discharge dates included).
Eligible stays	Eligible stays are all hospitalizations (length of stay greater than 24 hours) with at least a therapeutic surgical procedure. A surgical intervention was defined by the breaking of the skin or a mucous membrane, even if via endoscopic or endovascular approach. Aspiration, injection, catheterization, closed reduction of fracture without bone fixation device were not considered as surgical procedures. Deliveries were excluded. Procedures on body surfaces requiring only local anesthesia, that can be done in an office were also excluded.
Comments	In principle, following procedures are considered as feasible in one day surgery: - endoscopic procedures; - minimally invasive open access procedures; - moderately invasive procedures on a very small or a small organs; - highly invasive open access procedures on very small organs. Exceptionally, such procedures are considered as unfeasible in one day surgery, if they do not fulfill all the following requirements : - no undue risk of immediate complications (e.g. excess of blood loss); - a fast physiological recovery and early ambulation; - a pain treatment manageable without hospital infrastructure.
Scientific validation	A systematic review of hospitalizations candidates for one day surgery has been conducted on 135’376 eligible Swiss stays. The distribution of elective interventions whose feasibility in day care is well supported by literature has been examined. A random sample of US hospital stays shows that the rate of candidates to one day surgery was less than 5%, giving some evidence that the list of procedures considered as feasible in one day surgery is realistic. Lastly, it has been shown that almost all interventions reimbursable as semi-hospitalisation (less than 24 hours) in the canton Vaud in 2002 (Switzerland) were considered as not requiring an hospitalization by themselves.
Implemention	For more details about required data and material, format, software package implementation, click on the left button : Manuel technique (French) Technisches Handbuch (German)

Last update: July 9, 2009