Ernest Olszewski
Day-case surgery is widely advocated in the UK due to its benefits in efficiency, reduced healthcare costs, and improved patient experience. National policy recommends that approximately 75% of elective procedures be performed as day-cases, with unplanned overnight admission rates ideally below 2–3%. This audit evaluated the rate and causes of unplanned admissions following intended day-case surgery within a cohort of general surgical procedures and identified opportunities for service improvement.
A retrospective audit was conducted of patients undergoing procedures listed in the British Association of Day Surgery (BADS) directory between January 2024 and January 2025. The cohort comprised 423 intended day-case procedures, including appendicectomy, cholecystectomy, hernia repair, anorectal surgery, pilonidal sinus surgery, and abscess drainage. Overall, 393 patients (93%) were discharged on the day of surgery, while 30 (7%) required unplanned overnight admission. Clinical records for these admissions were reviewed to determine causes and assess whether same-day discharge was feasible.
Among the 30 admissions, three were due to documentation errors where patients had been discharged but incorrectly coded. Nine were clinically appropriate due to significant postoperative or medical concerns. The remainder were associated with potentially modifiable factors: late theatre scheduling (7), uncontrolled postoperative pain (7), urinary retention (3), and postoperative nausea and vomiting (PONV) (1).
Although most admissions were justified, the overall unplanned admission rate exceeded recommended benchmarks. Several potentially preventable factors were identified, highlighting opportunities for quality improvement through optimised theatre scheduling, enhanced anticipatory analgesic strategies, formal risk stratification for PONV, and improved perioperative measures to reduce urinary retention.
Authors
Ernest Olszewski, Rob Schofield
Countess of Chester Hospital, Chester, United Kingdom