With Minimally Invasive Technology and Optimized Workflow, Day Surgery Allows Patients to Leave the Hospital in 24 Hours

An increasing proportion of elective surgeries are now becoming “Day Surgeries,” or those that can allow a patient to be discharged in 24 hours. This means that a patient can complete any preoperative examinations, the operation, and be discharged all within 24 hours, allowing them to go home the same day as the procedure. In 2019 and 2020, the National Health Commission issued a number of manuals and regulations related to Day Surgery and announced the list of pilot hospitals that could conduct such procedures.

Day surgeries account for 60% to 70% of Beijing United Family Hospital’s annual surgeries. Pediatric surgeries make up 75.53% of Day Surgery cases, representing the largest proportion of such cases. Urology Surgery is also becoming more common, with the proportion of related Day Surgery cases increasing from 51.57% in 2017 to 62.25% in 2019.

Minimally invasive surgery is widely used, laying the technical foundation for Day Surgery

Day Surgery, also known as same-day surgery or ambulatory surgery, first emerged in the US and the UK in the 1950s. In order to reduce the financial burden of inpatient surgery, some smaller operations and surgical procedures were adapted to shorten the length of the patient’s hospital stay. Benefiting both the hospital and the patient, this type of procedure has developed quickly. The concept of Day Surgery in China is broader. Social factors such as individual differences in a patient’s physical condition and whether he or she is cared for at home are considered. Generally, as long as the patient does not stay in the hospital for more than 48 hours, it is considered a Day Surgery case.

Prof. Gang Zhu, Associate Chief Medical Officer and Chief Surgeon at BJU, said that the development of Day Surgery was first and foremost due to the improvement of medical technology. Endoscopic surgery, laparoscopic surgery, and other minimally invasive surgeries are more and more widely used, reducing the proportion of open surgery. As a result, the postoperative recovery has greatly improved. It is worth noting that internationally, the adoption of other types of surgery as outpatient procedures is also increasing. Surgeries including resection of bladder tumors, for example, are now becoming Day Surgeries.

Safe and Secure Anesthesia Supports Day Surgery

Anesthesia plays an important role in Day Surgery, explained Dr. Wei Liu, Associate Chief Medical Officer and Chair of Anesthesiology at BJU. First, the Anesthesia Clinic and Surgical Clinic are linked. The surgeon will first evaluate the basic condition of the patient, and if necessary, the Anesthesia Clinic will provide a second evaluation.

Second, during surgery, the amount of narcotic drugs needs to be precisely controlled. During anesthesia, preventive measures are taken to prevent complications such as pain, nausea, vomiting, and dizziness after surgery, as well as cognitive impairment in elderly patients. Only once patients have returned to their preoperative state for a minimum of 2 to 3 hours after the operation can they be discharged from the Hospital. Third, the patient needs adequate pain control after surgery. Multiple forms of analgesics are now widely used to minimize opioid use and to ensure that the patient does not have complications and is comfortable when discharged from the hospital. Nerve blocking anesthesia and non-steroid, anti-inflammatory drugs are often used. In addition, the patients are instructed on how to correctly use painkillers when they return home after surgery.

A Large Proportion of Elective Surgeries Can Be Day Surgeries

Currently, Day Surgery accounts for a high proportion of elective surgeries. According to General Surgeon Dr.Jing Liu, almost all medical institutions can support same-day surgery for certain skin diseases, like epidermal cysts. At BJU, by optimizing procedures and shortening hospital stays; gallbladder, hernia, appendicitis, and hemorrhoid surgeries as well as unilateral resection of the thyroid gland and breast mass surgery can all be day surgery procedures.

“Elderly patients usually require longer hospital stays, as it is necessary to observe their cardiopulmonary function during recovery, Dr.Jing Liu said. He emphasized that day surgery cannot be “one size fits all.” Sometimes longer hospital stays are needed based on the individual cases.

In the future, some larger abdominal surgeries, such as bowel resectioning and weight loss surgery (sleeve gastrectomy), can become Day Surgeries.

For working women, Day Surgery is more popular. Dr. Hongli Ma, Director of the Gynecological Minimally Invasive Research Center said that gynecological Day Surgery includes hysteroscopic surgery, cervical surgery, infertility diagnosis surgery, and tubal ligation. Some common procedures include the removal of cervical polyps, the removal of small submucosal fibroids, intrauterine adhesions, septal resection, and the removal of foreign bodies in the uterine cavity. Cervical surgery often includes conization of the uterine cervix, including cold knife conization and LEEP (Loop Electrosurgical Excision Procedure). For infertility, the gold standard examination is through the combined diagnosis and treatment of hysteroscopy and laparoscopy. Tubal ligation surgery can also be carried out using minimally invasive techniques. All of these procedures can be completed as outpatient procedures and the patient can be discharged on the same day.

Day Surgery accounts for the highest proportion of Pediatric Surgery cases. For example, adenoid and tonsil hypertrophy, which usually causes snoring in children, can be treated with outpatient surgery. Before surgery, doctors from multiple departments, including Sleep Medicine, ENT (Ear, Nose, and Throat), and Orthodontics, will comprehensively evaluate the child’s condition. They will communicate with the child’s parents to help them understand the treatment plan, medication needed, and postoperative care. The Child will only need to be observed in the hospital for one night, then can be discharged early the next morning.

Patient Acceptance is High. Day Surgery Becomes the Norm

In this unique year, in order to reduce the risk of cross-infection, the proportion of patients who have taken the initiative to request shorter hospital stays has increased significantly. As the pandemic has transitioned into a stage of ongoing prevention and control, the advantages of Day Surgery are becoming more prominent. With increased patient acceptance, a large number of outpatient operations have become the norm.

Prof. Gang Zhu said that Day Surgery allows patients to return to life and work as soon as possible, saving medical resources and improving bed turnover rate. Take ureteral stone surgery as an example. Traditional open surgery causes damage to ureteral muscles and organs meaning patients need several days to recover before being discharged from the hospital. However, with new minimally invasive techniques and the ureteroscope becoming smaller, there is no surgical incision in the patient’s abdomen, minimizing the physical damage from surgery.

At the same time, Day Surgery also reduces costs. Dr. Wei Liu said that highly-qualified management, collaboration within multiple departments, and optimized procedures are needed for a medical institution to safely implement Day Surgery. Specifically, the Day Surgery Center needs to coordinate with the relevant departments to schedule the entire perioperative process. The Center also needs to train the nursing team on how to teach patients about postoperative care in order to reduce the time needed in the hospital after the procedure. In addition, postoperative follow-up is needed, along with monitoring the patient’s condition after surgery, in order to ensure postoperative safety. The exploration and practice of ERAS (Enhanced Recovery After Surgery) are also important roles in accelerating the recovery of patients after elective surgery.

This article was written by Si Chen, author at the Beijing Youth Daily