DOES EARLY DISCHARGE FROM FOLLOW-UP INCREASE POST-OPERATIVE RE-ATTENDANCE RATES (SOS) FOLLOWING FOOT AND ANKLE SURGERY?

Abstract

Introduction: Long waiting times for surgery and government targets places added pressure on the administration of surgical units. In an effort to decrease waiting times from initial referral to surgery and to meet new to follow-up patient ratios set by the government, a policy of early discharge from follow-up was introduced for many procedures involving the foot and ankle. This audit assessed whether this policy increased procedure morbidity and patient dissatisfaction.

Methods: A 12-month retrospective audit was performed (October 2005 – September 2006) on the foot and ankle surgery cases performed at the Great Western Hospital, Swindon and Marlborough Trust, UK. Procedure and out-patient appointment data was accessed including new, follow up and ‘SOS’ patient attendances. Appointments were considered SOS if a patient sought consultation with a surgeon following discharge in the post operative setting.

Results: A total of 1128 foot and ankle procedures were performed on 639 patients. Eighty five percent (958) procedures met the early discharge from follow-up criteria. There were 2750 appointments for the respective period. Twelve hundred and seven (44%) were new patient appointments and 1543 (56%) were follow-up appointments. There were 84 SOS attendances related to a surgical episode, comprising 2% of appointments and 6% of procedures. Sixty-seven of the SOS attendances (80%) were related to an early discharge from follow-up procedure. A high proportion of SOS attendances were associated with joint stiffness, digital malposition and dysesthesia relating to Hallux Valgus correction, lesser digit arthrodesis and intermetatarsal neurectomy respectively.

Discussion: In this series, the aforementioned complications are consistent with those reported in the literature and we conclude they were not a consequence of early discharge. Early discharge from follow-up following selected common surgical procedures for the foot and ankle can potentially increase productivity of the out patient department without impact on procedure morbidity and patient satisfaction.