|Day Surgery Article|
|Publication Status||3b (Australian Surgeon August 1993)|
|Copyright||Copyright of this article is vested in the author. Permissions for reprints or republications must be obtained in writing from the copyright holder. This article has been republished here with permission from the copyright holder. (Scanned from The Australian Surgeon. If there is any discrepancy between this scanned reproduction and the original the original takes precedence.)|
Every Effort Should be made to Ensure Specialty Groups Utilise Day Surgery to their Maximum Potential
Lindsay Roberts, FRCS FRACS
Chairman, Australian Day Surgery Council, 1990 â€“ 2000
President Elect, International Association For Ambulatory Surgery 1999
(The Development & Present Status Of Day Surgery In Australia. 2nd European Congress On Ambulatory Surgery).
The National Day Surgery Committee in Australia commenced as a working party in 1980 to prepare standards for the establishment and development of modern, high quality day surgery. The first publication of standards was produced in 1981 and revised in 1987.
The first modern, highly sophisticated freestanding day surgery centre was built in Victoria in 1982. However, there was very little activity or interest, either by the medical profession or government, until 1985. Several other free-standing day surgery centres were built in the various Australian States during 1985/1986 and the original working party was formalised as a Committee, with its activities directed exclusively to standards. In 1988, recognising that the Committee needed to address the broader aspects of day surgery other than standards, it changed to the National Day Surgery Committee.
The Committee has a central body and two expanded groups. The central body is made up of two representatives each of the Australian Association of Surgeons, the Royal Australasian College of Surgeons, the Australian and New Zealand College of Anaesthetists and the Australian Society of Anaesthetists.
The first expanded group includes representatives of all the specially surgical associations with the addition of a nurses representative. The second expanded group is made up of representatives of the various other major organisations associated with the delivery of health care and includes the Australian Medical Association (representing general practitioners), the Australian Private Hospitals Association (representing the private hospitals), the Australian Hospital Association (representing the public hospitals), the National Association of Day Surgery Centres (representing the free-standing day surgery centres), the Australian Health Insurers Association (representing the private health insurance organisations), the Health Insurance Commission – Medibank Private (representing the government health insurance commission) and the Gastroenterology Society of Australia (representing gastro-intestinal endoscopy).
The structure of the Committee, as outlined above, provides the widest possible representation of organisations associated with the delivery of health care in Australia and, as such, is the most informed advisory committee on day surgery in Australia. The committee receives input from medical practitioners and organisations associated with the delivery of health care and government, and functions as an advisory body to the profession, health care organisations and government.
The construction and licensing of day surgery centres is a State responsibility and each State prepares its own mechanism for this purpose. Where a licence has been granted to a day surgery centre there is a simple process of registration with the Federal Government for the payment of day surgery facility insurance rebates. A separate body, the Australian Council on Health Care Standards is the accreditation organisation for the maintenance of standards.
Various types of day surgery centres in Australia include free-standing day surgery centres, day surgery units in private and public hospitals and day surgery centres in suburban, central urban and rural areas. Some important aspects of these centres include:
- Free-standing day surgery centres can be developed both in central urban and suburban city areas, given appropriate design consideration. The most common and effective unit has two operating theatres with a total area of approximately 700 m2 and cost between 1.75 and 2 million Australian dollars.
- Where day surgery units are developed within private or public hospitals every attempt should be made to allot an appropriate dedicated section of the hospital for this purpose. and where possible should include its own operating theatres. In most hospitals, however, day surgery patients would have to use the general operating theatre unit.
- In the larger rural centres, free-standing centres can be developed and can include an operating theatre and an endoscopy room. The viability of these centres is yet to be proved.
- It is generally accepted that separate induction rooms. although ideal, are not necessary for day surgery and add significantly to the cost of construction.
- One of the most common observations emanating from existing units is the inadequate size of the pre-discharge area with emphasis that this important section of day surgery centres should be much larger and contain more chairs / lounges, with a ratio of probably 1.5 to two chairs for every recovery trolley.
One of the remarkable observations in the utilisation of day surgery in Australia has been the marked variation of support by the different specialties from one day surgery centre to another.
As day surgery expands to reach its potential of approximately 50 per cent, every effort should be made to ensure that all specially groups utilise day surgery to their maximum potential.
My speciality is the surgical management of breast pathology, with particular emphasis on the treatment of breast cancer. It may be of interest to examine the application of day surgery to the various breast operations.
A series of 102 breast operations was examined with specific emphasis on the duration of stay in hospital. There were 20 cysts which were aspirated in the consulting room and 54 operations which were carried out as day surgery. A further 28 patients required overnight admission.
The majority of day surgery operations were for biopsy or biopsy with frozen section. However, a small number of more extensive operations were also carried out in day surgery and these included biopsy with wire localisation, segmental excision with or without frozen section and limited axillary lymph node dissection.
There are only two mastectomy operations, reflecting the practice in our clinic of treating the majority of breast cancer by wide local excision and radiotherapy. This is not the forum to discuss the surgical treatment of breast cancer, so suffice to say that radical dissection of the axilla for carcinoma of the breast has been eliminated and replaced by limited excision of the axillary lymph nodes (low or mid-axillary level).
In summary, 35 of the 48 procedures for benign breast pathology were carried out in day surgery and 19 of the 44 breast cancer operations were carried out in day surgery. It is likely that an even greater number of cancer operations in the future will be carried out in day surgery as the National Breast Screening program progresses and breast cancer is diagnosed at an earlier stage with smaller tumours.
As of January 1993, there were 83 freestanding day procedure centres in Australia. An important observation is the development of day medical centres as indicated in the list and there is considerable scope for the expansion of these centres as well as day surgery centres.
The expansion of both day surgery and day medicine to its potential of approximately 50 – 60 per cent of procedures must surely have a significant effect in curtailing the overall cost of providing procedural services whilst also reducing waiting lists.
Our Committee supports the formation of an International Committee and an International Organisation of Ambulatory Surgery to advise and assist the expansion of day surgery throughout the world.