AUDIT OF THE PRACTICE OF DAY CASE SURGERY IN THE DIVISION OF PAEDIATRIC SURGERY, UNIVERSITY COLLEGE HOSPITAL, IBADAN

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D.I Olulana^1,2, O.O Ogundoyin^1,2, T.A Lawal^1,2, K.I Egbuchulem¹, J.O Akpakwu¹, S.A Adegbite¹

1. Division of Paediatric Surgery, Department of Surgery, University College Hospital, Ibadan.
2. Department of Surgery, University of Ibadan, Ibadan.

Abstract

Background: Paediatric day case surgery refers to planned procedures on patients on a non-resident basis but requires some facilities and time for recovery before discharge home on the day of surgery. This study was conducted to audit paediatric day case surgery practice at our centre, and to determine the outcome of day case surgeries.

Patients and Methods: This is a retrospective study of cases seen over a period of 12 years, 2010 to 2022. These patients’ data were assessed from their case notes and information obtained for each of the patients included age, gender, diagnosis, type of operation, type of anesthesia and post operative complications. The data were analyzed using SPSS version 22.0 for windows.

Results: A total of 1,211 patients were recruited, with a M: F; 6: 1. The age of patients ranged from one week to 15 years with a median age of two years. A higher proportion of case load involved infants and toddlers compared to the other paediatric age groups. In this review, the largest volume of cases was seen in the last five years with the peak in 2018 (202). The right groin for an isolated diagnosis was operated in 381 (59 %) patients compared to the left 265 (41 %). The mean duration of surgery time was 40 minutes. Most of the patients had General Anesthesia (GA) with endotracheal tube, face mask, and laryngeal mask airway (LMA) using isoflurane, halothane and propofol at different times as anesthetic agents. There were no re admissions or mortality, however two of our patients had recurrence necessitating a re-do surgery.

Conclusion: Groin hernias are the most common day cases in children in our facility. Day case paediatric surgery is safe, and outcome is generally good, when well managed.

Keywords: Audit, Day case, Nigerian, Paediatric, Surgery

Introduction

The concept of Paediatric day case surgery is becoming an increasingly important part of elective surgery worldwide ranging from groin and genital surgeries to intermediate surgeries such as excision of masses like thyroglossal duct cysts.

Paediatric day case surgery is defined as planned investigations or procedures on patients on a nonresident basis; that is, they are admitted and discharged home on the day of their surgery but requires some facilities and time for recovery.^1-3.

Day Case Surgery (DCS) – in the USA, is restricted to Surgeries within 23 hours whether there is an overnight stay while in the United Kingdom (UK), surgeries are done without a night stay. Ambulatory surgery, is like DCS (UK)

In the case of an office surgery, the patient returns home few hours after procedure and in outpatient surgery, the patients are not fully investigated, and no prior admission is made.

Day case paediatric surgery has many advantages including minimal disruption of parents occupational activities with early return to work and normal activity for care givers, reduced waiting list, psychological benefits to both patient and care giver, efficient management- high volume, low risk surgery, reduced complications, Job satisfaction to the surgical team, little change in children environment and less time off school, cost benefit, risk of contracting nosocomial infection is eliminated, other siblings at home can be catered for too. It is advised that families should attend a pre-assessment visit to allow for a thorough explanation of peri-operative sequence of events with particular emphasis on pre-operative fasting and regular medications. ^1-5

Patient Selection Criteria
Day case surgery is particularly appropriate for children provided, the operation is not complex or prolonged and the child is healthy with no significant co-existing medical illness. ⁶

1. Patient and medical related factors; include Term baby greater than one month of age, Preterm baby greater than 60 weeks, well controlled systemic disease, the patient should not have inborn errors of metabolism, should not have complex cardiac disease requiring investigations, should not be Hemoglobin SS patient and no ongoing active infection especially respiratory tract infection.
2. Anaesthetic and Surgical factors; include Experienced surgeon or anesthetist, short procedure not greater than one hour, no opening of body cavity, pre-operative baseline PCV greater than 30 %, Minimal blood loss and no need for transfusion, post-operative pain should be relieved by oral analgesics alone, should not have difficult airway, not be susceptible to malignant hyperthermia, not a sibling of a victim of sudden infant death syndrome.
3. Social factors: Caregivers consent, and their willingness to care for the child at home postoperatively, good housing condition, should have telephone line, Journey time to hospital less than onehour, Adequate post-operative transport arrangement. ^7-9

There has been a gradual increase in the number of patients treated as day case surgeries in our division and this informed the decision to conduct this review to audit Paediatric day case surgery practice in the Division of Paediatric surgery, University College Hospital, Ibadan.