Kirtana Ponnuswamy & Amitraj Dalip
Kirtana Ponnuswamy, Amitraj Dalip, Jonathan Burke, Seeraj Bugren, Manoj Natarajan, Aftab Khan
East Kent Hospitals University Foundation Trust, Margate, United Kingdom
Abstract
Aim
Getting It Right First Time (GIRFT) is a national initiative to homogenise and improve the treatment pathways amongst various NHS trusts. Unplanned admissions after day surgery results in unexpected cost and burden to the NHS. In this study, we investigated the causes for unplanned admission of patients undergoing laparoscopic cholecystectomy, paraumbilical hernia repairs and inguinal hernia repairs.
Method
A retrospective analysis of day surgery cases over a period of one-year ( January 2022 – January 2023) was undertaken. All patients pathways were compared against the GIRFT pathway/guidelines.
Result
A total of following cases were identified as unplanned admissions: 51/282 (22%) Laparoscopic Cholecystectomies ,7/55 (14.5%) Paraumbilical hernia repairs , and 18/152 (12%) Inguinal Hernia repair cases . The main causes for unplanned admissions for laparoscopic cholecystectomies were high-risk patients booked as day case (5 cases), complex intra-operative procedures (11 cases), and post-operative complications/social reasons (4 cases); for paraumbilical hernia repairs, the causes included social concerns, obstructive sleep apnea and extended post-op recovery; for inguinal hernia repairs the main causes were urinary retention (5 cases) and high-risk patients booked as day case (11 cases).
Conclusions
For majority of the cases, the GIRFT pathway was followed. However, most of the unplanned admissions had predictable and preventable causes which require optimisation.
Causes such as urinary retention in Inguinal Hernias repairs could benefit from a standardized pathway for discharge and pre-counselling. Waiting periods and pre-operative investigations specifically in Laparoscopic cholecystectomies need to be closely examined to predict intra-operative complications. High risk patients need thorough pre-op assessments in all procedures to reduce the overall percentage of unplanned stays.