Chi Sum Hannah Sung
Introduction
SWAOC is a dedicated surgical hub at the re‐established Nightingale Exeter, created to support elective recovery across Devon. Originally focused on high‐volume, low‐complexity hip and knee arthroplasty, the
service has expanded to include a broader range of ambulatory subspecialty procedures including spinal surgery. The spinal service delivers a variety of decompressive procedures, including bilateral single‐level and unilateral two‐level decompressions, discectomies, and microdiscectomies aiming for day case pathways.
Method
The project aimed to standardise pre, peri and postoperative pathways, first developed within the HVLC arthroplasty programme and then adapted for other subspecialties. For spinal surgery, standardisation covered eight MDT components: pre‐operative preparation; pre‐medication and warming; anaesthetic approach; surgical LIA; post‐anaesthetic recovery; secondary recovery; therapy input and discharge
medications.
Results
A total of 191 patients underwent spinal surgery with a day case rate of 94% compared with the BADS benchmark of 30%. Patient feedback was highly positive: 94% of patients were contacted the day
following surgery of whom 88% rated their experience as good or very good. Pain outcomes were also excellent, with 70% reporting mild or no pain and 27% reporting moderate pain.
Conclusion
SWAOC has standardised care pathways for this surgical group, achieving outstanding day case rates.
Enhanced analgesic protocols have improved immediate postoperative pain control, supporting earlier mobilisation and better therapy engagement. As a dedicated elective hub with no trauma or medical outliers, SWAOC consistently delivers safe, effective and efficient care while maximising productivity and achieving excellent patient outcomes.
Authors
Katharine Littlejohns, Royal Devon University Healthcare Trust, Exeter, United Kingdom
Olivia Haynes, Royal Devon University Healthcare Foundation Trust, Exeter, United Kingdom
Dr Mary Stocker, Royal Devon University Healthcare Foundation Trust, Exeter, United Kingdom & Torbay and South Devon NHS foundation Trust, Torbay, United Kingdom
Exeter Spinal Team, Royal Devon University Healthcare Foundation Trust, Exeter, United Kingdom