Introduction: Utilisation of day case surgery units for orthopaedic trauma is an uncommon concept. Limited reports of its use in specific orthopaedic trauma cases have been encouraging. There is currently no formal provision for day case surgery for trauma patients at our institution. The aim of this study was to identify the proportion of trauma patients that would be suitable for daycase surgery and the proportion of these that currently undergo procedures as a day case, with a view to establishing a more formalised daycase trauma service. Methods: We undertook prospective data collection on all trauma referrals in our institution over a 1 month period in January 2008. Information was recorded for date and time of referral, admission, operation and discharge. Nature of injury, type of procedure performed, grades of surgeon involved and length, nature and reason for any pre or post-operative delay was also recorded. All patients requiring surgery were assessed on their suitability for day case as defined by pre-determined patient-related and surgery-related criteria. Results: Of all the patients referred during the study period 129 patients required surgery. Of the operated patients 80 (62%) had a procedure suitable to be performed as a day case as defined by surgical factors. Of these, 57 (44%) patients met criteria for day surgery as defined by patient factors. Of those eligible for day case surgery (n=57), only 27% had their procedures performed as a day case. The total number of additional days spent in hospital by day case eligible patients was 69. 34 days were due to pre-operative delay and 35 were due to post operative delay. The mean number of pre operative days in hospital was 1.33(range 0–3) and post operative days 1.85 (range 0–8). There was a wide case mix of procedures performed that were deemed appropriate for day case surgery. 76% were upper limb or soft tissue procedures.The causes for pre-operative delay established two main issues. Limited dedicated operating theatre capacity for day case eligible procedures resulting in their de-prioritisation and limitations on dedicated bed availability. The cause for postoperative delay was more variable but on the whole was for reasons which with appropriate protocols could have been avoided. Conclusions: This study has identified that a significant proportion of orthopaedic trauma workload would be appropriate to be carried out as a day case. Without an appropriate day case surgery setup, current delays are causing 69 unnecessary bed days per month in our institution. Causes for current delays are related to lack of synchrony between timing of admission and surgery and lack of appropriate discharge protocols. We are in the process of developing a plan for implementation of a dedicated day case trauma service at our institution and suggest that this may be an appropriate use of day case facilities in other trusts

Recent Department of Health guidelines have recommended that bunion surgery should be performed as a day case in a bid to reduce hospital costs, yet concurrently improving patient outcomes. Following an audit in 2012/3, we implemented a number of measures in a bid to improve the rates of day case first ray surgery. In this paper, we look to see if these measures were effective in reducing the length of stay in first ray surgery. We performed a prospective case note review of all patients undergoing first ray surgery between 01/01/2012 and 01/02/2013, and found the rates of same day discharge in this group to be lower than expected at just 24.19%. We recognised that the most commonly cited reasons for delayed discharge were that patients not being assessed by physiotherapy, and were unable to have their take home medication (TTO's) dispensed as pharmacy had closed. To address this, we implemented a pre-operative therapy led foot school, and organised ward analgesia packs which may be dispensed by ward staff, thus bypassing the need for pharmacy altogether. Together, we coined the term “care package” for these measures. We then performed a post implementation audit between 01/01/2014 to 01/01/2015 to ascertain if these measures had been effective. We identified 62 first ray procedures in the preliminary audit, with an average age of 50.5 years (range 17–78 years) and a M:F ratio of 1:5. The most commonly performed procedures were Scarf osteotomy, 1st MTPJ fusion, and distal Chevron osteotomy. We compared this to 63 first ray procedures post implementation of the care package. The average age was 55.3 years (range 15–78 years) and the M:F ratio was 1:2.5, and there was a similar distribution in terms of specific procedures. We found the length of stay had reduced from 1.00 to 0.65 days (p= 0.0363), and the rate of same day discharge had increased from 24.6% to 44.6% (p= 0.0310). We also noted that St Helens Hospital (SHH), the dedicated day case surgery unit, had a significantly increased rate of same day discharge than Whiston Hospital (WH- the main hospital) at 87.5% and 28.89% respectively (p= 0.0002). Preoperative physiotherapy assessment is an important tool in reducing length of stay for first ray surgery. The use ward analgesia packs has a synergistic effecting in increasing day case first ray surgery. We therefore commend its use to other centers. Additionally, we have shown dedicated day case surgery units are more effective at achieving same day discharge than general hospitals

Introduction/aims. Anterior cruciate ligament (ACL) reconstruction is now routinely performed arthroscopically. However, there are only a few centres in the UK which offer this procedure as a day case. We aimed to assess the clinical outcomes of day case ACL reconstruction using a tourniquet-less pump regulated procedure. Material/methods. A retrospective analysis of day case ACL reconstructions by a single surgeon between January 2003 and December 2010 was undertaken. All reconstructions were performed without a tourniquet, instead, haemostasis was achieved using saline – epinephrine irrigation. Outcomes were measured using Lysholm knee scores, Mohtadi index and pain scores. Results. 374 ACL reconstructions were performed on 331 patients (288 unilateral, 43 bilateral) during the study period. The average age was 31 years (range 15–58 years). All patients were followed up at regular intervals for 12 months. Lysholm knee scores improved from an average of 25 to 90. Mohtadi index scores also showed significant improvement; from an average of 22 to 90 post-operatively. All patients were pain free by 6 weeks post ACL reconstruction based on the VAP score. Complications occurred in 3% (n=11) of patients, these included DVT, wound infection and haemoarthorosis. Metal work failure occurred in 2 patients, both of whom had the EZLoc™ fixation system. Conclusions. Our experience shows that day case ACL reconstructions without the use of a tourniquet are cost effective, safe and the patients' preferred choice. Perhaps, therefore, it is time to include ACL reconstructions in the British Association of Day Case Surgery “basket” of day case procedures?

Day case surgery is commonplace in the field of orthopaedic surgery, being suitable for a wide range of both trauma & elective procedures. It became apparent within our unit that an unacceptably high number of cases were being cancelled for a variety of reasons. We set out to identify these reasons and thereby develop a simple screening process to reduce the number of cancellations. Initial audit over a 1 year period showed 25% of the 907 day case patients were being cancelled. We subdivided the reasons for these cancellations at both pre-operative assessment and on the day of surgery into avoidable [e.g. no carer / telephone, uncontrolled BP, high BMI and ischaemic heart disease] and unavoidable [e.g. surgery no longer required, patient unwell, list cancelled for emergencies, patient DNA]. The majority of our cancellations fell into the “avoidable” category, predominantly at pre-operative assessment. Accordingly, we devised a simple screening questionnaire to be used by clinicians in out-patients at the time of listing for surgery, based on the RCS guidelines (1985). If any of the questions were answered “Yes”, the patient was not suitable for day case surgery. The patient information letter was also changed, informing patients that non-attendance would result in their removal from the waiting list. Re-audit of 727 patients over the next 12 months showed a fall in cancellations to only 11%, with the majority of these being for unavoidable reasons. Cancellations are a source of inconvenience, distress and frustration to both clinician and patient, are a waste of hospital time and resources, and lead to an increase in waiting lists. Our study demonstrates the value of closing the loop in audit, leading to a dramatic reduction in cancellations. Audit is a useful tool to improve patient care, and is not merely a “number-crunching” exercise

Background. PROMs have become an integral assessment tool of clinical effectiveness and patient satisfaction. To date, PROMs for lumbar discectomy are not an NHS requirement, although voluntary collection via the British Spine Registry is encouraged. Despite this, PROMs for day case microdiscectomy is scarcely reported. We present PROMs for day case microdiscectomy at Lancashire Teaching Hospitals. Aims. 1). To review PROMs to quantify leg pain, back pain, EQ5D and ODI scores. 2). Evaluate PROMs data collection compliance. Methods. We studied PROMs data, taken prospectively as part of routine clinical care for all patients who underwent single level day case microdiscectomy between January 2013 to December 2015. PROMs included VAS for back and leg pain, EQ5D and ODI scores. Preoperative PROMs were compared to all available postoperative PROMs at 3 months, 6 months, 12 months and 24 months. Paired student T-tests were used to compare preoperative to postoperative scores. Results. Preoperative PROMs were recorded for 132 patients. Postoperative PROMs were recorded for 48 patients at 3 months, 51 patients at 6 months, 37 patients at 12 months and 15 patients at 24 months. Significant postoperative improvements (p<0.05) were found at all time points for back pain, leg pain, EQ5D and ODI, with the exception EQ5D at 24 months (p = 0.10). Conclusion. There was significant improvement in VAS back and leg scores, as well as ODI scores over 24 months. Further work is needed to improve compliance with postoperative PROMs and to optimise the benefit of these health assessment tools. No conflicts of interest. No funding obtained

While many forefoot procedures may be performed as a day case, there are no specific guidelines as to which procedures are suitable. This study assessed the early post-operative pain after forefoot surgery performed a day case, compared with conventional inpatient management. A total of 317 consecutive operations performed by a single surgeon were included in the study. Those eligible according to the criteria of the French Society of Anaesthesia (SFAR) were managed as day cases (127; 40%), while the remainder were managed as inpatients. . The groups were comparable in terms of gender, body mass index and smoking status, although the mean age of the inpatients was higher (p < 0.001) and they had higher mean American Society of Anaesthesiologists scores (p = 0.002). The most severe daily pain was on the first post-operative day, but the levels of pain were similar in the two groups; (4.2/10, . sd. 2.5 for day cases, 4.4/10, . sd. 2.4 for inpatients; p = 0.53). Overall, 28 (9%) of patients who had their surgery as a day case and 34 (11%) of inpatients reported extreme pain (≥ 8/10). There were more day case patients rather than inpatients that declared their pain disappeared seven days after the surgery (p = 0.02). One day-case patient with excessive bleeding was admitted post-operatively. Apart from the most complicated cases, forefoot surgery can safely be performed as a day case without an increased risk of pain, or complications compared with management as an inpatient. Cite this article: Bone Joint J 2015;97-B:1645–50

Anterior cruciate ligament reconstruction has been traditionally performed as an inpatient due to post-operative analgesic requirements. Increased patient demands and pressures of bed shortages have led to the development of day case surgery. Day case anterior cruciate ligament (ACL) reconstruction surgery using an analgesic pump was assessed. 24 consecutive ACL reconstructions using arthroscopic hamstring technique were performed as day case procedures. All received a standard anaesthetic of propofol, fentanyl, tenoxicam, and morphine. And an intra-articular administration of 10mls 0. 75% Ropivicaine Hydrochloride at the end of surgery. 0. 2% Ropivicaine at a rate of 2mls/hr was infused over 48hrs using a compression spring infusion pump (Pain Control Infusion Pump – Sgarlato Labs) via an intraarticular catheter. Post operative pain was assessed by a Visual Analogue Score (VAS) recorded by the patient onto an unmarked 1 Ocin line (0 – no pain ; 1 0 – maximum pain). For the 48hrs the pump was infusing the average VAS was 2. 7 with minimal additional analgesia required. Following pump removal by a District Nurse, the average VAS score was 1. 9 with similar analgesia requirements. All patients were satisfied with their care; none had problems related to the use of or removal of the pump; none required re-admission or review from their GP; or suffered post-operative complications. The cost for day case surgery was 260 (including theatre time; pump and drug costs; District Nurse costs) compared to 1072 for an average in-patient stay of 4 days (both exclude ACL specific implants, surgeon and anaesthetist costs). The intra-articular infusion of local anaesthetic has been shown to be well received by patients with no additional risks. It is an effective and cost-effective means of providing post-operative analgesia allowing day case ACL Reconstruction surgery to be performed. This study has demonstrated that there are no requirements for additional resources from primary care

In the National Health Service although some units perform ACL reconstruction as a day case, others continue to admit patient’s overnight due to a possible medicolegal implication of complication including postoperative pain, nausea and vomiting and urinary retention. The aim of this study is to assess the safety, efficacy of post operative pain control, cost effectiveness of the day case procedure and the role of extended acute ‘hospitalcare in the community’ by a Rapid Response Team. We carried out a retrospective review of data of fifty-seven patients who underwent day case ACL reconstruction with pre-emptive analgesia and postoperative pain control with analgesics and non-steroidal anti-inflammatory drugs. Rapid Response Team consisting of qualified nurses who provide intensive level of nursing cares in-patients home provided the postoperative community care. Aim of this team is to reduce the pressure of acute hospital beds. Out of fifty-seven patients, adequate pain relief was achieved in 92.8%. One patient needed admission for pain relief, one patient needed admission for excessive bleeding and five patients had nausea and vomiting. Cost analysis showed that ACL reconstruction is cost effective. We conclude that ACL reconstruction is a safe procedure provided attention is given to patient selection, preadmission screening, patient education, preemptive analgesia with appropriate pain management and post operative community care

Aim Pressure on inpatient beds can lead to high cancellation rates for inpatient elective orthopaedic surgery. The use of day surgery facilities is one way to overcome this problem. We set out to assess patient satisfaction after Scarf osteotomy, as a day case procedure, to help determine whether this is a valid routine practice. Method Twenty-six consecutive patients (25 female and 1 male) undergoing Scarf metatarsal osteotomy, lateral release, medial capsulorraphy, and Akin osteotomy were prospectively followed up. Three patients had bilateral procedures resulting in 29 operations being performed. All had their surgery under midfoot block with intravenous sedation administered by an anaesthetist. All patients were discharged on the day of surgery with oral analgesia and contact details of the on-call orthopaedic registrar. A telephone interview and questionnaire were performed on day 3 and day 7 post-operatively. Results Post-operative pain: seven patients (24%) had no pain, 15 (51%) mild pain, five (17%) moderate pain and two (6%) had episodes of severe pain. Twenty-eight patients (96%) were satisfied with their level of postoperative analgesia. Twenty-eight patients (96%) would have the surgery as a day case again. One patient would not due to post-operative nausea and vomiting. Post-operative problems experienced by patients: 17 patients (58%) had no problems, six (20%) felt that their pain was a problem, five (17%) experienced bleeding/bruising and one (3%) felt faint. Survey of medical services contacted by patients: 26 (89%) contacted no-one, one (3%) day surgery unit staff, two (3%) their GP and one (3%) the hospital. Significance Scarf osteotomy can be successfully performed under midfoot block with a high degree of patient satisfaction. This has the potential to reduce cancellations due to inpatient bed shortage

Day case Anterior Cruciate Ligament (ACL) reconstruction has recently become accepted as a safe and reliable technique. One major advantage of day case procedures is the reduction of cancellations due to bed availability leading to a more predictable admission for the patient. Traditionally this advantage has not always been available to service personnel due to the combined problems of distance from the hospital and lack of a suitable and safe environment for discharge. These problems can be overcome by the close cooperation with the local Medical Reception Station. During 2000 a total of 29 day case ACL reconstructions were performed. There were no cancellations for non-clinical reasons. Of these 29, 12 were performed on service personnel of whom 8 were based at a significant distance from the hospital. A total of 6 patients were treated via the Medical Reception Station (MRS) for overnight stay after the operation. There were no significant complications at the MRS and all patients have returned to normal duty. There were no postoperative complications in this group of patients. We suggest that the advantages of day surgery can be extended to servicemen by the use of the MRS as a temporary accommodation. This should prevent soldiers operations from being cancelled and reduce time away from operational units. This practice could be extended to all aspects of surgery suitable for day case procedures

Background. Despite interest, the current rate of day-case anterior cruciate ligament reconstruction (ACLR) in the UK remains low. Although specialised care pathways with standard operating procedures (SOPs) have been effective in reducing length of stay following some surgical procedures, this has not been previously reported for ACLR. We evaluate the effectiveness of SOPs for establishing day-case ACLR in a specialist unit. Methods. Fifty patients undergoing ACLR between May and September 2010 were studied prospectively (“study group”). SOPs were designed for pre-operative assessment, anaesthesia, surgical procedure, mobilisation and discharge. We evaluated length of stay, readmission rates, patient satisfaction and compliance to SOPs. A retrospective analysis of 50 patients who underwent ACLR prior to implementation of the day-case pathway was performed (“standard practice group”). Results. Eighty percent of patients in the study group were discharged on the day of surgery (mean length of stay=5.3 h) compared to 16% in the standard practice group (mean length of stay=21.6 h). This difference was statistically significant (p< 0.05, Mann-Whitney U test). All patients were satisfied with the day case pathway. Ninety-two percent of the study group were discharged on the day of surgery when all SOPs were followed and 46% where they were not. Conclusion. High rates of day-case ACLR with excellent patient satisfaction can be achieved with the use of a specialised patient pathway with SOPs

The aim was to demonstrate that day case Anterior Cruciate Ligament (ACL) reconstruction, without the use of a tourniquet, is clinically effective, cost effective, safe and “patient choice” procedure. Fifty patients who underwent day case, arthroscopic, ACL reconstruction without the use of a tourniquet, but using saline and epinephrine, pump regulated, irrigation. The same surgeon performed each case for the period May 2003 to April 2005. Seven patients had their tendons reconstructed with the use of patellar tendon grafts, the remainder, 43 patients, had hamstring tendon grafts. The study included 6 women and 44 men. This prospective study assessed cost effectiveness, clinical efficacy by measuring post-operative pain and postoperative results and finally whether this procedure remained the “patient choice”. The mean age was 30.6 years, (range 16 – 46). In addition to assessing level of immediate post operative pain the patients were also assessed at two weeks and six weeks for pain, range of movement, swelling and for the occurrence of any early post-operative complications. We were able to show that there was a significant cost benefit, approximately one third to a half in comparison to other local surgeons; that the study was clinically effective and that there were no reported early complications; and that all 50 patients would choose to have the surgery again as a day case procedure with this technique. We would like to present day case ACL reconstruction without the use of a tourniquet, as a safe option for the carefully selected patient

This is a report of 30 patients who underwent arthroscopic, Anterior Cruciate Ligament (ACL) reconstruction without the use of a tourniquet, but using saline and epinephrine, pump regulated, irrigation. Each case was performed as a day case by the same surgeon for the period May 2003 to December 2004. 5 patients had their tendons reconstructed with the use of patellar tendon grafts, the remainder, 25 patients, had hamstring tendon grafts. The study included 4 women and 26 men. This prospective study assessed cost effectiveness, clinical efficacy by measuring post-operative pain and post-operative results and finally whether this procedure remained the “patient choice”. The mean age was 30.6 years, (range 17 – 46). In addition to assessing level of immediate post operative pain the patients were also assessed at two weeks and six weeks for pain, range of movement, swelling and for the occurrence of any early post-operative complications. We were able to show that there was a significant cost benefit, approximately one third to a half in comparison to other local surgeons; that the study was clinically effective and that there were no reported early complications; and that all 30 patients would choose to have the surgery again as a day case procedure with this technique. We would like to present day case ACL reconstruction as a safe option for the carefully selected patient and as a procedure that could perhaps be included in the orthopaedic basket for day case surgery in the UK

Post-operative pain is well recognised in patients undergoing shoulder surgery. With the recent advances in arthroscopic shoulder surgery over the last decade, a larger number of cases are being performed in day surgery units. These procedures are generally performed under general anaesthetic with either an interscalene or suprascapular nerve block or local anaesthetic infiltration. The aim of our prospective audit was to investigate the adequacy of analgesia provided for patients, undergoing day case arthroscopic shoulder procedures in a rural district general hospital, to ensure best medical care and to tailor certain procedures to appropriate analgesic pathways in the future. Fifty consecutive patients, who underwent day case arthroscopic shoulder surgery, were contacted by telephone one week post surgery, to assess their post-operative pain scores and analgesic requirements. Patients who received a nerve block were found to have a significantly longer duration of pain relief (p < 0.001). These patients also had significantly less pain performing their usual activities of daily living in the immediate post-operative period (p = 0.05), compared to patients who only had local anaesthetic infiltration. There was no trend found between the type of procedure and post-operative pain scores. Our audit has confirmed that nerve blocks provide longer pain relief, but has also highlighted the need to take into consideration pre-operative pain and pain perception to enable analgesia to be tailored

Aim. To assess the safety of day case lumbar decompressive surgery. Method. Retrospective study of 233 consecutive patients undergoing DCLDS who were identified from a prospective electronic database. Results. Between Jan 2011 and April 2014, 131 open and 102 microscopic surgeries were done in patients with mean age of 46 (16–88) years and male: female ratio of 136 (59%):97 (41%). Inclusion criteria were no known anesthetic reaction, ASA grade I or II, BMI <35, less than 30 minutes travel time and responsible home carer. Patients were discharged after clinical assessment with cauda equina advice and emergency contact number. 215 (92%) procedures were single level, of which 188(87%) unilateral and 27 (13%) were bilateral procedures. 18 (8%) procedures were multiple levels, of which 12(67%) unilateral and 6 (33%) were bilateral procedures. Majority, 107 (50%), 97 (45%) procedures were done at L5/S1 and L4/L5 levels respectively and rest 11(5%) at higher level. The 7 day and 30 day re-presentation figures were 7 (3%) & 15(6.4%) as following: Pain (n=3), Medication (n=2), Wound issues (n=5), Infection (n=2), Headache (n=2), ?VTE (n=1). Eleven were sent home and 4 (1.7%) were admitted with 2 requiring further surgery, one revision discectomy and one wound washout. No cauda equina or compressive haematoma were encountered. Conclusion. This study demonstrates that open and microscopic lumbar discectomy at single or multiple levels can be performed safely as a day case procedure. The representation rate to the ED can be potentially reduced by better advice and pain management. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Arthroscopic procedures may be associated with considerable pain in the first 24 hours. Intra-articular bupi-vacaine provides good analgesia but is short lasting. Intra-articular morphine has been shown to prolong postoperative analgesia in knee and ankle arthroscopy. The aim of this study is to assess the safety and analgesic effect of intra-articular morphine following day case wrist arthroscopy. Ethical approval was firstly obtained. 31 patients were randomly assigned to one of 2 groups in a double blind clinical study. Group 1 received 5ml of 0.5% bupi-vacaine intra-articularly with 5mg of morphine subcutaneously. Group 2 received 5ml of 0.5% bupivacaine and 5mg of morphine intra-articularly. There were 15 patients (mean age 41.2 years) in group 1, and 16 patients (mean age 38.9 years) in group 2. Postoperatively pain was assessed using a 100mm visual analogue pain scale (VAPS) at 1, 2, 6 and 24 hours. Analgesia requirements were recorded at these times post operatively. The presence of nausea, vomiting, other complications and patient satisfaction were recorded. Visual analogue pain scores did not show any significant difference between the groups at 1, 2, 6 and 24 hours. Supplementary analgesic consumption over the 24 hour period was slightly greater in group 1 than in group 2. None of the patients who had intra-articular Morphine had vomiting nor any other complications and did not require anti-emetics. Most patients in either group were satisfied with the level of postoperative analgesia. Intra-articular bupivacaine with or with out morphine provides adequate postoperative pain relief following wrist arthroscopy. There seems to be little difference between the two methods studied

Knee arthroscopy is the most commonly performed orthopaedic operation world wide. There is however little data on the incidence of DVT and consequently there is no consensus regarding the need for periopeartive thromboprophylaxia. Hoppener et al,2003 reported a high incidence of 11% DVT without the use of thromboprophylaxis. The aim of our study was to establish the incidence of venous thromboembolic complications in day case knee arthroscopy without any thromboprophylaxis. A retrospective review of 458 consecutive knee arthroscopies done in our unit between Feb 1998 to May 2007 were carried out. They were all day cases and did not receive any chemical thromboprophylaxis. All the case notes were carefully scrutinized for any readmissions for symptoms of venous thromboembolism(VTE). The clinical signs documented were pain, tenderness, swelling or redness of the legs, dyspnoea, chest pain and haemoptysis leg pains or redness following the surgery. There were 278 males and 180 females. The age group ranged from 15 to 88 years. The average age group was 57.7years. The primary out come of the study was the incidence of symptomatic and asymptomatic venous thromboembolic complications after the knee arthroscopy during the 2 week and 8 week followup period. Our study showed there were no cases of symptomatic deep vein thrombosis in any of the patients. The pooled overall estimate of the incidence of all VTE, without the use of thromboprophylaxis was 7.4%, symptomatic 2% and asymptomatic 5.4%. This is not in agreement with our study. The limitation of our study, it is a retrospective analysis and no investigative tools were used. We conclude that until more extensive studies have been performed, it seems justified to withhold thromboprophylaxis in patients undergoing uncomplicated knee arthroscopic procedures in a daycare setting

Aim: To assess pain control, functional outcome and patient satisfaction following day surgery ACL reconstruction.

We report the results of 60 consecutive primary anterior cruciate ligament (ACL) reconstructions performed by a single operator at King’s College Hospital Day surgery unit. A “3 in 1” nerve block was used after general anaesthesia. Semitendinosis and gracilis were harvested from the ipsilateral side, doubled and implanted arthroscopically. Patients were discharged the same day with oral analgesia. The mean age was 34.7 years old (range 18–58). Mean period between injury and reconstruction was 26.9 months (range 6–63 months). Mean follow-up was 38 months (range 7–86 months). Average post operative pain score was 3.86 with an average analgesic requirement of 11.2 days (range 0–50 days) Mean Modified Lysholm score was 85.63 (range 31–100) and mean IKDC score was 79.83 (range 37–100).

In conclusion we found that following day surgery ACL reconstruction, pain relief was adequate in most cases, functional outcome was rated good or excellent by 78% of patients and 91% were satisfied with the overall service.

Aims

Day-case knee and hip replacement, in which patients are discharged on the day of surgery, has been gaining popularity during the last two decades, and particularly since the COVID-19 pandemic. This systematic review presents the evidence comparing day-case to inpatient-stay surgery.

Introduction. Day Case Surgery (defined as same day discharge) is a priority within the National Health Service and has been shown to provide beneficial outcomes for patients and hospitals. We report our experience developing a Day Case Programme for Total Ankle Replacement (TAR). Methods. Prior to the introduction of a Day Case Programme, average length of stay following TAR in our unit was 3.5 days. Stakeholders were consulted about ways in which same day discharge could be facilitated. Patients' post-operative pain charts were reviewed prior to the introduction of this programme. Inclusion criteria included non-complex surgery (anticipated tourniquet < 2hrs), friend or relative support and pre-operative walking-aid assessment. An enhanced recovery protocol included long-acting popliteal block and dexamethasone. Patients were discharged with opiate analgesia and written pain instructions. Patients were asked to complete a pain and satisfaction questionnaire. Patient Reported Outcome Measures (PROMs) were recorded. Results. From September 2017 to April 2019 21 of 70 patients underwent TAR as a Day Case. Mean age was 67 years (43-85 years). Complications included two delayed wound healings and one representation on day three with urinary retention. No patients reported post-operative nausea or vomiting, 60% did not use Oramorph at home. Average Visual Analogue Score for pain was 23/100 on day one and 21/100 day three post-operatively. There was no significant difference in pre-operative or overall change in MOXFQ, VAS or EQ5D PROMS. Conclusions. Early results suggest that Day Case Total Ankle Replacements are safe. Appropriate patient selection is necessary. Day Case Surgery relies on support and communication between multiple teams to organise and run effectively