Randomized clinical trial of the effectiveness of emergency day surgery against standard inpatient treatment

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Abstract
Background The aim of this study was to assess the feasibility of treating patients with minor and intermediate general surgical emergency conditions as day cases. Methods Emergency referrals for minor and intermediate general surgical conditions were assessed by a surgeon. Those fitting day-case criteria and requiring operation under general anaesthesia were randomized to receive standard inpatient care or day surgery. Patients in the latter group were booked on to day-case lists or gaps on inpatient elective lists for surgery within 48 h. The process was coordinated by an experienced theatre sister. Results One hundred patients were randomized. There was a reduction in the number of nights spent in hospital in the day-case group (median 0 versus 2 nights; P < 0·001). The median time from diagnosis to treatment was 1 day in both groups, although there was a small but significant delay in the day-case group (P = 0·018). There was no significant difference in postoperative outcome or patient and general practitioner satisfaction. The day-case option had no increased impact on primary care services but was associated with a significant saving of about £150 per patient (P < 0·001). Conclusion Certain general surgical emergencies may be managed as day cases with cost saving but without detriment to patient care.