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A step in the right direction: Enhanced recovery foot and ankle surgery in a dedicated Day Surgery Unit

Gemma Salt, Jonathan Nicholson, Sue Deakin, Phil Vaughan, Frances Henderson
West Suffolk Hospital, Bury St Edmunds, United Kingdom


Introduction: As part of our post-pandemic recovery, we designed and implemented an enhanced recovery programme to allow patients to undergo midfoot and hindfoot surgery in a dedicated day surgery unit (DSU), at our district general hospital. We prospectively audited the outcome and patient satisfaction of the first cohort.

Methods: 12 suitable, ASA 1 & 2 patients, listed for a midfoot or hindfoot operation were enrolled into a DSU enhanced recovery pathway. Length of stay, post-operative pain scores, patient satisfaction scores and surgical outcome were recorded. Patients received telephone follow up at day 1 by the Surgical Care Practitioner and then attended for face-to-face review at 2, 6 and 12 weeks.

Results: All patients underwent morning surgery, under general anaesthetic & popliteal block. They were discharged from DSU, with opiate analgesia, the same afternoon. Mean length of stay was 9hrs 05minutes. Patients were discharged, non-weight bearing in a back slab, with a functioning block that remained effective for a mean of 18.8 hrs. Patients self-recorded their pain scores and use of analgesia for 48hrs post-operatively. There were no complications or readmissions. All patients reported a successful clinical outcome by 12 weeks and were very satisfied with the pathway.

Conclusions: We suggest that our enhanced recovery pathway facilitates patients having the right procedure in the right place. This surgery can be performed both safely and successfully, with high patient satisfaction, in a dedicated DSU. We propose broader use of such a pathway to support post-pandemic recovery and a move away from unnecessary inpatient admission.