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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
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.improve.
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