Abstract
Background
Benefits of day case foot and ankle surgery includes reduced hospital stay, associated cost savings for the hospital, high patient satisfaction and quicker recovery with no increase in complication rates.
In 2007, we set up the preoperative foot and ankle group. Patients were seen three weeks before surgery by a specialist nurse, physiotherapist and a preoperative evaluation is done. The therapist explains the patient's weightbearing status and advices on how to carry this out. Our aim was to reduce inpatient hospital stay and increase our day case procedures.
Methods
We evaluated length of stay and physiotherapy intervention for all our patients during the first three months of 2007 to 2011. Mean length of stay was calculated and Mann-Whitney U test was performed using median.
Results
Mean length of stay for combined forefoot and midfoot group reduced by 1.92 days and median reduction was statistically significant(p< 0.01). For forefoot surgery alone, the mean length reduced by 2.14 and median reduction was significant(p< 0.001) and for midfoot surgery alone, the mean stay reduced by 1.34 days and median was significant (p< 0.001).
Hind foot patient's mean length of stay reduced by 6.78 days and the median was significant (p< 0.001). But for the ankle group the mean length of stay did reduce but the median was not statistically significant (p=0.225).
Day case surgery increased by 43.5% for forefoot, 23.2% for midfoot and 14% for ankle surgeries but not for hindfoot.
Conclusions
The overall results show that the preoperative foot and ankle group has resulted in reduction of inpatient stay and increase in daycase surgery performed.
A pre-operative group is a highly efficient method of enhancing patient care and improving length of stay at the hospital for the patient. The cost saving for the hospital is around £35,400 per annum.
