Year : 2017 | Volume
: 10 | Issue : 1 | Page : 1--2
Day care ophthalmic surgeries at a secondary care hospital in Oman: Our experience
Jagdish Bhatia, Bindu Narayanadas, Albert Alfy Hafez Gad, Mathew Varghese, Makari Adel Mansi
Department of Ophthalmology, Rustaq Regional Hospital, Rustaq, Oman
Department of Ophthalmology, Rustaq Regional Hospital, P.O. Box 421, PC 329, Rustaq
|How to cite this article:|
Bhatia J, Narayanadas B, Gad AA, Varghese M, Mansi MA. Day care ophthalmic surgeries at a secondary care hospital in Oman: Our experience.Oman J Ophthalmol 2017;10:1-2
|How to cite this URL:|
Bhatia J, Narayanadas B, Gad AA, Varghese M, Mansi MA. Day care ophthalmic surgeries at a secondary care hospital in Oman: Our experience. Oman J Ophthalmol [serial online] 2017 [cited 2017 Mar 23 ];10:1-2
Available from: http://www.ojoonline.org/text.asp?2017/10/1/1/200691
Day care surgery is defined as scheduled surgical procedures provided to patients who do not require hospital stay overnight.
In recent years, there has been a major switch from inpatient care to day care for ophthalmic surgical procedures. This change has found favor with most patients and clinicians and has been greatly facilitated by the advent of small incision cataract surgery (phacoemulsification and small incision cataract surgery). The trend toward more day case surgery is likely to increase as the number of beds in Ministry of Health is not increasing in proportion to increasing number of patients.
Benefits of day care surgery are:
Decompression of busy hospital beds, Cost containment, Less nosocomial infections, and Early recovery in home environment with the family.
However, in a country such as Oman, with social factors, we are still not able to cash on all the advantages of day care surgery in our hospitals.
In the USA, a saving of 15%–30% and in the UK, a saving of 40% in the cost have been reported with the day care surgery. Although no official data are available in Oman, a conservative estimate could be 30% of cost savings for each day care surgery.
Factors Relevant to the Success of Day Care Surgery
Day care surgery demands the highest standards of professional skills and organization. Listed below are some of the factors relevant for the success of day care surgery.
Patient selection Patient information Preoperative assessment/tests Proper anesthetic and postanesthetic care Patient acceptability Audit.
This is the key to the successful day care surgery. Selection is not only a matter of choosing patients with conditions that may be treated on a day care basis but also involves shifting out those patients who are unsuitable for medical and social reasons. The current exclusion criteria adopted by our department for patient selection are shown.
Exclusion Criteria for Outpatient Surgery
Unfit American Society of Anesthesiologists (ASA) IV, ASA III Blood glucose level more than 11 mmol Blood pressure >180/100 mmHg.
Factors related with patients
Concept of day care surgery unacceptable to the patient and relatives Psychologically unstable If patient lives far away from the hospital.
No competent relative or friend to accompany or drive the patient home after operation To look after him or her at home for the next 24 h.
Setup of Day Care Unit at Rustaq Hospital
Patients are referred to the preanesthetic clinic 1–3 days before surgery by the ophthalmologists after getting the routine investigations done. An anesthesiologist reviews the patient and advises further investigations/consultations as and when applicable.
The patient is instructed to come on the morning of surgery to the ophthalmic outpatient department at 7.15 am and then immediately taken to day care ward. All day care patients are given topical antibiotic drops (ofloxacin eye drops) and dilating drops (tropicamide minims) and are instructed to start instilling them from morning at around 6 am. Hence, by the time they reach the hospital, they had topical antibiotic cover and have dilated pupil.
Comprehensive and well-presented information using lay terminologies in local language for patients and their relatives is essential for the success of day surgery and it is provided to the patient.
An asymptomatic low-risk patient does not need a battery of screening tests unless the medical history or the physical examination suggests otherwise. In pediatrics, routine complete blood count (CBC) and sickling evaluation are done. In adults above 40 years, in addition to CBC and sickling, electrocardiogram and chest X-ray and serum glucose are also advised. The preoperative assessment should be detailed and similar to inpatients.
Monitored anesthesia care
Monitored anesthesia care is a common practice in our setup. In the present setting of Rustaq Hospital, the anesthesiologist's role is to provide the surgeon with the best possible operating conditions and the patients with the safest and most pleasant experience.
After the operation, vital signs are monitored till the patients are ready to be discharged. A detailed discharge slip is given, including the details of the procedure/postoperative analgesia and follow-up appointment. The first follow-up is recommended for the next day.
Day care ophthalmic surgeries were commenced in Rustaq Hospital from December 2014. In year 2015, 34% (179) of total eye surgeries (532) have been performed as day care surgeries. After initial hiccups, patients have accepted day care surgery well.
Methods of gauging the acceptability of day care surgery in patients are to look for a number of unsolicited complaints, incidence of readmission after patients have returned home, and postoperative complication rates. The positive feedback from the patients and their relations will enhance the popularity of outpatient surgery in years to come.
In our case, none of the day care patients required readmission, and we do not report any postoperative complication such as iris prolapse and hyphema in any of the day care patients. All the patients accepted the day care surgery very well.
Day care eye surgery is a cost-effective surgery that has expanded rapidly in recent years. At the moment, there is a lack of any standard practice and uniform policy in Oman for ophthalmic day care surgeries. An ideal setting for day care eye surgery in Oman should be hospital based with a strong social backup and satisfactory transport. Appropriate auditing is desired.
|1||Association of Anaesthetists of Great Britain and Ireland; British Association of Day Surgery. Day case and short stay surgery: 2. Anaesthesia 2011;66:417-34.|
|2||Wig J. The current status of day care surgery. A review. Indian J Anaesth 2005;49:459-66.|