Modifying and increasing day-case procedures to solve local problems: Experience of a urology unit

BACKGROUND: Surgical ward congestion continues to be a problem across rural Africa. Day-case surgery has helped minimize this problem in most developed countries but remains underdeveloped across Africa. The objective of this study was to carefully expand day-case services within the framework of already existing hospital infrastructure. MATERIALS AND METHODS: Seventy-one consecutive patients out of 149 mostly urologic patients that met the study criteria were treated and followed up on a daycase basis over a 15-month period. In the absence of a day surgery unit, these patients were prioritized and operated on urologic theater days while adequately utilizing the equipped preoperative holding area for patient recovery. Patients were all nonemergent, of American Society of Anesthesiologists’ physical status (ASA-PS) classes 1 and 11 and accepting to undergo day-case procedure among other selection criteria. The main outcome measures were to determine the percentage reduction in admission rate and encountered complications. RESULTS: Forty-nine (69%) of these 71 patients were treated using local anesthesia. The day-case surgery rate for the urology service was increased to 47.65% from a previous rate of 21.6%. Six patients (8.4%) felt that their postoperative pain was more significant than they had anticipated. Postoperative nausea and vomiting occurred in two patients (2.8%). There was one case of scrotal hematoma that resolved on observation. There was no mortality. CONCLUSIONS: In the absence of a dedicated day-case service, individual specialists should develop or increase safe lists of cases in their respective fields that can be done on a day-case basis in order to reduce demand for in-patient beds.