| Day-case anaesthesia in adult knee arthroscopy: With special reference to recovery and cost-effectiveness after general and spinal anaesthesia | ||
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The application of outpatient surgery with early ambulation (day-case surgery) is approaching its centenary. Nicoll was one of the first surgeons to challenge the established doctrine that patients required prolonged bed rest following surgery. He demonstrated that a procedure conducted on an outpatient basis cost 10 times less than a similar procedure accomplished using inpatient facilities (Nicoll 1909). There are even earlier reports of the physiological advantages of early ambulation and the disadvantages of prolonged bed rest (Ries 1899). Churchill et al. (1927), Asher (1947) and Wright (1951) were also in favour of early ambulation.
The progress was slow in Europe, where the prevailing medical opinion remained firmly against day-case surgery until the early 1950s, when Farquharson described an inguinal herniorrhaphy operation done on an outpatient (Farguharson 1955). In the USA, day surgery began to gain ground in the late 1960s, when Wallace Reed and J L Ford built the first modern free-standing outpatient facility in Phoenix, Arizona, in 1969 (Reed & Ford 1974). The Society for Ambulatory Anesthesia was founded in the USA in 1984, and the British Society of Day Surgery was founded in London in 1989. The first International Congress of Ambulatory Surgery was held in Brussels in 1995. In Finland, outpatient surgery has been performed mainly since the 1970s (Korttila 1975), but day-surgery was performed even earlier by ear, nose and pharynx surgeons in Kuopio during the 1950s (professor Juhani Nuutinen, personal communication).
Day-case surgical procedures represent a large and increasing fraction of all surgery throughout the world. Data from the USA show that the percentage of outpatient surgery grew from 20% in 1981 to 69% in 1996 (SMG Marketing Group 1996). The percentage of outpatient surgery in Finnish hospitals was 24% in 1997 (Punnonen 2001), and it is estimated to rise up to 50% by the year 2003 (Suomen Kuntaliitto 1998).
Table 1. Achievements in day-case surgery.
| Authors | Achievements |
|---|---|
| Ries (1899), USA | Showed that patients improved more with early ambulation and had fewer complications. |
| Cushing (1900), USA | Described hernia repairs using cocaine as a local anaesthetic. |
| Nicoll (1909), UK | Reported on a series of 8988 outpatient operations on congenital abnormalities in children, conducted between 1899 and 1909. He stressed the need for good selection of patients. |
| Hospital for Sick Children (1910–1914), Canada | First reported use of day-case surgery in Canada. |
| Waters (1919), USA | Established a downtown anaesthetic clinic in Sioux City. |
| Strittmatter (1925), USA | Carried out three 15-minute dilatation and curettage procedures a day over the preceding 15 years, using ethyl chloride as an anaesthetic. |
| Churchill & McNeil (1927), UK | Observed reduction in vital capacity with prolonged postoperative stay in bed compared with early ambulation. |
| Herzfeld (1938), UK | Reported 1000 paediatric herniotomies, many conducted on an outpatient basis. |
| Israel & Mazer (1938), USA | Confirmed the safety of office curettage in a large series of patients. |
| Leithauser (1946), USA | Book published to argue for early ambulation. Editorials in the British Medical Journal (1948) and the Lancet (1951) took an opposite view. |
| Wright (1951), UK | Showed an adverse effect of bed rest on venous blood flow compared with early ambulation. |
| Palumbo et al. (1952), USA | Demonstrated fewer postoperative complications with ambulation from day 1 postoperatively compared with days 7 or 14. |
| Farquharson (1955), UK | Conducted 485 herniorraphies on outpatients. Recommended appropriate patient selection, cooperation with general practioners and no restriction on age. He argued that a reduction of the conventional 10- to 14-day hospital stay would save 4850 bed days and reduce waiting lists. |
| Stephens & Dudley (1961), UK | Long waiting lists prompted the establishment of an outpatient surgical service in Aberdeen, Scotland. Good patient selection and high standards in anaesthesia, surgery and assessment were recommended. |
| Lawrie (1964), UK | First used the term “day surgery” and had used this type of surgery for a number of years because of its obvious benefit to children and their families. |
| Godber (1967), UK | Chief Medical Officer recommended the concept of day surgery, but gives no specific guidance. |
| Dornette (1968), USA | Suggested the establishment of independent day-surgery facilities. |
| Williams (1969) and Ruckley et al. (1971), UK | Suggested criteria for effective and successful day surgery. |
| Reed & Ford (1974), USA | Established the “Surgicenter” in Phoenix, Arizona. The claim to the first free-standing surgical centre came from Providence, Rhode Island, in 1968 (Marks et al 1980). |
| Korttila (1975), FIN | Outpatient anaesthesia in Finland: drugs used and postoperative care of patients |
| Ogg (1980), UK | Defined the stages of recovery from ambulatory anaesthesia |
| Royal College of Surgeons of England (1985), UK | Publication of detailed guidelines for day-surgery. |
| Audit Commission (1990), UK | Further recommendations for increasing the use of day-case surgery. |