Published: 01/07/2004, Volume II3, No. 5912 Page 24

The drive to carry out more operations as day cases will put trusts under increasing pressure, says Roger Taylor

Increasing the number of operations performed as day surgery is generally regarded as a good thing. The NHS plan set out the intention to increase this and significant resources were made available. One of the issues looked at by the former Commission for Health Improvement was the ability of trusts to treat patients as day cases.

For many patients, having an operation and being home the same day is far more convenient than staying overnight in hospital. For hospitals, the ability to perform operations with the minimum use of inpatient beds greatly increases the capacity to treat patients. Every spare piece of capacity is vital.

There has been a steady increase in day-case surgery over the past seven years. The Audit Commission has identified 25 procedures that can generally be performed as day surgery and has suggested that overall at least 75 per cent of such operations should be done in this way.

Dr Foster looked at the hospital episode statistics to see what percentage of patients treated for these operations had a length of stay of less than one day - ie were not admitted overnight. This definition is not precisely the same as day-case treatment since some patients admitted in an evening, treated and discharged the next morning would be regarded as day cases even though they would show up as having stayed overnight in hospital.

We included all trusts that recorded at least 1,000 admissions over the period for the basket of operations.

The first chart shows that the percentage of patients discharged on the same day has risen from 56 per cent in 1995-96 to 67 per cent in 2002-03 - a steady improvement but still short of the 75 per cent benchmark.

The second chart shows the spread across trusts for the percentage of the 25 operations where the patient was discharged on the same day as the procedure. It shows a fairly tight concentration around the average, with about half the trusts performing between 60-70 per cent of operations in this way, and only one trust with less than 40 per cent done as day cases.

However, the third chart takes the example of inguinal hernia repair. This is among the 25 procedures identified as suitable for day-case surgery but it is much less commonly done as such. Nationally only 47 per cent of patients having this operation are discharged on the same day.

As well as a lower day-case rate on average, there is a much greater spread between trusts, with more trusts at both extremes but, in particular, many more trusts with relatively low day-case rates. Almost one in six hospital trusts does less than 30 per cent of these operations in this way.

The most common procedures tend to be focused on first - cataract operations, for example, where day-case treatment is now standard in most hospitals. As the drive to increase day-case rates across the NHS continues, the procedures that need to be transferred over to day-case management will be increasingly challenging.

Roger Taylor is research director of health information specialists Dr Foster.