Day Case GreenLight Laser Photoselective Vaporisation of the Prostate (GL-PVP)

Background and ObjectiveIn recent years, GreenLight laser photoselective vaporisation of the prostate (GL-PVP) has emerged as the primary ablative surgical treatment option for symptomatic bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPE). Unlike the reference procedure, monopolar-transurethral resection of the prostate (M-TURP), GL-PVP can be performed as a day case. As waiting list pressures continue to burden health boards across the UK, exacerbated by the COVID-19 pandemic, enhanced access to day case surgery to optimise patient flow is now of paramount importance. We evaluated the safety and feasibility of day case GL-PVP at our high-volume UK centre and identified predictors of a postoperative overnight stay. Material and MethodsWe performed a retrospective observational cohort study of all patients who underwent primary GL-PVP at a single institution between October 2016 and June 2021. All procedures were performed utilising the 180W GreenLight XPS™ laser therapy system. Various clinical, operative and functional data were collated, and outcomes were compared between patients who underwent day case surgery and those admitted overnight postoperatively. ResultsIn all, 538 patients underwent GL-PVP during the study period. Median patient age was 72 (interquartile range (IQR) 66–77), and median prostate volume was 62.5cc (IQR 45–90). Five hundred nineteen patients (96.5%) were discharged within 23 hours of admission, and 366 patients (68.0%) were managed as a true day case. Operative and functional outcomes were comparable between patients managed as a day case and those admitted overnight. There was higher patient-reported satisfaction and a lower rate of early hospital readmission in the day-case group. On univariate logistic regression analysis, patients aged ≥80 years (Odds Ratio 2.64 [95% Confidence Interval 1.65– 4.24], p = < 0.001), those with American Society of Anaesthesiologists (ASA) physical status classification score ≥3 (OR 1.92 [95% CI 1.33–2.78], p = < 0.001), those with prostate volume ≥80cc (OR 1.62 [95% CI 1.00–2.61], p = 0.05) and those in whom the operation time ≥60 minutes (OR 1.66 [95% CI 1.10–2.52], p = 0.02) were more likely to be admitted overnight following GL-PVP. On multivariate logistic regression analysis, age ≥80 (OR 2.64 [95% CI 1.47–4.73], p = 0.001) and ASA score ≥3 (OR 2.03 [95% CI 1.28–3.22], p = 0.003) remained predictive variables of an overnight stay. ConclusionFrom our observations of a large cohort of patients over a study period of almost five years, day case GL-PVP is a feasible concept and does not appear to compromise perioperative outcomes. With appropriate service redesign and optimisation of postoperative patient pathways, day case GL-PVP can be established in other centres and may have a role in alleviating waiting list pressures.

Oxford Handbook of Clinical Surgery

This new edition of the Oxford Handbook of Clinical Surgery is thoroughly revised with the latest guidelines, management algorithms, and guidance on decision-making. It features three new chapters, on day case surgery, remote and rural surgery, and emergency surgery. The book also offers surgically relevant anatomy and physiology, quick reference symbols, key diagrams, and a focus on evidence-based practice with key references throughout. It is thoroughly comprehensive, without sacrificing the clear, concise, and quick-reference style the Oxford Medical Handbooks are known for. Ultimately, the new edition provides an accessible pocket reference for surgical trainees, medical students, and all those involved in the care of the surgical patient.

Day case surgery

This chapter studies day case surgery. The definition of day case surgery is the planned day admission of a patient to hospital for a surgical procedure, after which there is subsequent successful and safe discharge back home on the same day. The main rationale behind day surgery is to get patients discharged home following their operations in a safe and timely manner instead of spending prolonged periods within the hospital as an inpatient. This has significant implications, including reducing hospital stay, hospital-acquired infection, and healthcare-related costs while also improving patient experience and service efficiency. Surgical, anaesthetic, and patient factors should be considered for successful day case surgery. The chapter then traces the history of day case surgery, before detailing the common day surgery procedures.

Specific circumstances

This chapter brings together a series of small but important topics relevant to the practice of anaesthesia. First, the oncological impact of anaesthesia is explored. Next, the specific circumstances of anaesthesia for laser surgery are discussed. The third topic is robotic-assisted surgery. The fourth is anaesthesia for day-case surgery. The next two topics are the neurological determination of death, and organ donation surgery. The chapter closes with a discussion of how to handle a major anaesthetic mishap.

638 The Implication of Telephone Consultations During COVID-19 Pandemic on Informed Consent

Aim Is to find whether telephone consultations have affected patient’s comprehension of the proposed surgical management and possible risks until the day of surgery and accordingly ability for informed consent. Method This study included a sample of patients admitted to QEQM hospital for elective day case surgery during November 2020 and had only telephone consultation when referred for surgery. A feedback survey assessing quality of information given to patients before and on day of surgery was filled by the patients after the procedure. Results The sample included 40 patients undergoing different procedures [cholecystectomy (25), inguinal hernia repair (25), rectal examination under anaesthesia (5), ventral hernia repair (2), incisional hernia (2), inguinal lymph node biopsy (1)]. It was found that 27.5% of patients didn’t have thorough explanation of possible risks and no explanation about postoperative care in 35%.20% were not provided a leaflet about procedure, 57.5% had concerns before surgery and 75% of patients wished for a leaflet with illustrative diagrams, explanation of risks with their management to be able to take the right decision and majority of these patients were from cholecystectomy subgroup. Conclusions The lack of face-face appointment affected greatly the informed consent process resulting in patient dissatisfaction which raised the need for new leaflets containing diagrammatic explanation of procedures and possible risks with their management to ensure fulfilment of autonomy principle.