IngentaConnect Day-case septoplasty and unexpected re-admissions at a dedicated ...

Authors: Georgalas, Christos¹; Obholzer, Rupert¹; Martinez-Devesa, P.¹; Sandhu, G.¹

Source: Annals of The Royal College of Surgeons of England, Volume 88, Number 2, March 2006 , pp. 202-206(5)

Publisher: The Royal College of Surgeons of England

Abstract:

INTRODUCTION: Septal surgery has been identified as suitable for day-surgery, but is not widely performed as such. Guidelines for day-surgery state that the unexpected admission rate should be 2-3%. Previous audits have not achieved this figure and septoplasty is not universally considered suitable for day-surgery. We have reviewed practice over 4 years in our institution to identify surgical and patient factors associated with unexpected admission following septoplasty.

PATIENTS AND METHODS: A retrospective case note based audit of day-case septoplasty procedures reviewed at the end of each year between October 1998 and October 2002.

RESULTS: A total of 432 septal surgery procedures were performed, comprising 378 septoplasties and 54 submucous resections. Thirty-eight patients were admitted, overwhelmingly because of haemorrhage in the immediate postoperative period, giving an overall admission rate of 8.8% within the first 24 h. Factors associated strongly with re-admission were the use of intranasal splints, the performance of revision surgery, submucous resection (as opposed to septoplasty) and, less so, the performance of additional procedures and the peri-operative administration of diclofenac. There was no correlation between unexpected admission and grade of surgeon, surgical technique or any of the patient factors analysed.

CONCLUSIONS: The unexpected admission rate of septal surgery performed at our unit is above that recommended for day-case procedures, but is within the range previously published. Patient satisfaction with day-case septoplasty has been shown to be high. We believe that septoplasty should be performed in this setting but there is a significant chance that patients may need admission, and a pathway should be in place for this to occur with minimal disruption to the patient.

Day-case septoplasty and unexpected re-admissions at a dedicated day-case unit: a 4-year audit