Learn about Day Surgery

 

What is Day Surgery?

Day surgery allows the patient being admitted to the centre for preoperational evaluation, surgery, postoperative care, recovery, and discharged home the same day. It is often referred to as ambulatory surgery or outpatient surgery.

 

Day surgery is established in Europe and US, and has greatly evolved these years. Since 1980s, the day surgery cases in the United States become increasingly important. From 1985 to 1994, the percentage of elective surgery undertaken on a day basis in the USA increased from 34% to 61% and in the UK from 1989 to 2003 from 15% to 70%. In August 2002, the UK department of Health defined the surgeries including colonoscopy, gastroscopy, cataract surgery, haemorrhoidectomy, tonsillectomy, Carpal Tunnel Decompression, Excision of Ganglion, Bunion Operations, and Arthroscopy can be completed in a day surgery approach. In European countries, day surgeries represented 33% to 74% of the total surgical procedures in 2009. Around 48 million cases are completed in a day surgery approach in 2010. Day surgeries are fully developed in Europe and US and can reduce the amount of inpatient hospital admission.

 

Hong Kong has introduced the concept of day surgery since a decade. Hospital Authority (HA) has been working closely with the private healthcare sector and carried out several collaborative programmes to provide the public with more healthcare choices and enhance the service quality. From 2008 to 2012, collaborative programmes including cataract surgery, haemodialysis, imaging examinations, and outpatient services were carried out. Based on the statistics of HA in April 2018, the rate of day surgery in Hong Kong was close to 40%. Day surgery is now recognised and accepted by the public and sees a higher operation theatre utilisation rate. There is an increase among the citizens about the recognition of day surgery.

 

The Development of Day Surgery

With a population of 7.48 million, Hong Kong embraces seven hospital clusters to serve the whole city. The Hong Kong healthcare system is composed of two sectors: a private track and a government sponsored public track. Due to the limited medical resources and patient overload in Hong Kong public hospitals, the long wait is an undeniable result of increased demand for specialty services. For stable cases, it even takes around 86 weeks to wait for referral from GP to SP services in Surgery Department in 2018. Private healthcare prices including surgeon’s fee, operation theatre fee, inpatient charges, anaesthesia fee and other miscellaneous charges, however, are extremely high. Compared with inpatient surgeries completed in public hospitals or private hospitals, day surgeries feature short waiting times, low cost and can ease the burden on public healthcare. Day surgery centres, therefore, become an alternative featuring affordable and fair pricing, shorter wait times, less complications due to the delay in treatment, and finally, provide the limited healthcare resources of public hospitals to patients in need. Local government encourages the development of day surgery in several ways by proposing different health programmes. More and more public hospitals create the day surgery centre, and private healthcare facilities introduce the day surgery approach to meet the demanding needs in the market. In 2016, HA launched the Colon Assessment Public-Private Partnership Programme to provide a subsidy for eligible patients to receive related services from private specialists. Patients, thus, have more healthcare choices, and can book the medical examinations and receive in-time treatment. As the need for more day surgery is widely recognised, the market witnessed an increase in day surgery centres affiliated to public and private hospitals for efficient triage and a relief of the burden on hospitals. The Private Healthcare Facilities Ordinance has been gazetted on November 30, 2018. The government provides certain conditions for all day surgery centres or clinics to meet. And the service providers should get the licence to continue to operate. The Regulation protects patients’ safety and maintains their rights. It can, as well, promote the development of medical system in Hong Kong.

 

Moreover, on 1^st April, the Voluntary Health Insurance Scheme (“VHIS”) was introduced by the Food and Health Bureau. Day surgeries, such as minor operations and endoscopy procedures conducted in day centres are covered. It provides the public with an additional choice of private healthcare services through hospital insurance and relieves the pressure on the public healthcare system in the long run.

 

 

Technological Competence and Service Scope

Day surgery centres, different from GP/SP, can provide consultations and physical check-ups. A comprehensive day surgery centre can be described as a “mini-hospital” guided by the same international accreditation standards in the field of public hospitals. In the recent years, the day surgery is becoming more and more common and important. It requires a high-standard operating procedure including staff training on a regular basis, expanding service scope, and introducing the latest technologies. Day surgery centre is now capable to provide a range of endoscopy services including colonoscopy, gastroscopy, cystoscopy, microscopic examination of ears, nasoendoscopy, flexible laryngoscopy, fibreoptic laryngoscopy, and sleep endoscopy; general surgeries that include haemorrhoidectomy, breast lump excision, anal fistula, circumcision, inguinal hernia repair, anal abscess incision and drainage, etc; as well as imaging services, such as MRI scan, CT scan, X ray, low-pain mammogram, ultrasound, echocardiogram, resting ECG and treadmill exercise ECG.

 

 

Why Should I Choose Day Surgery?

Day surgery has positive influence on patients, family members or home care providers, service quality of medical care, and the operation and management of healthcare system.

• Improving the consultation time and no delay in treatment

Day surgery centres can make patient waiting times shorter. In the centre, patients can complete physical check-ups, endoscopy procedures and imaging examinations. Day surgery, therefore, can have shorter average consultation time per patient, but provide appropriate treatment. Patients can return home on the same day of the operation. They can receive personalised care in the familiar surroundings of their own home that can make the recovery quicker.

 

• High patient satisfaction

In 2007, two hundred patients who attended pre-anaesthetic assessment clinic between 1 January and 30 June 2004 were invited to participate in a survey on attitude towards day-case surgery in Hong Kong. In all 200 respondents completing the survey, 180 preferred day-case surgery. It is recognized as a useful treatment for routine and common surgical procedures.

 

• Decrease in Complications

Both day surgeries and inpatient surgeries attach the same importance on the concern for safety. A comprehensive day surgery centre can be described as a “mini-hospital” with adequate facilities and services as those in public hospitals. Day surgery has increased in popularity thanks to the advanced surgical techniques (i.e. minimally invasive methods) and special instruments that can help prevent the soft tissue damage. With the effect of controlled anaesthesia and sedation during the procedure, patients can have a safe surgical care in the day surgery centre and enjoy higher surgery success rate. Day surgery is proved to be safe with a low frequency of complications.

 

However, some risks and complications may be related to the anaesthesia. The most frequent complications include nausea and vomiting, and sore throat. When going under Intravenous (IV) Sedation or general anaesthesia, the unconscious patients cannot actively protect themselves. The Specialists of anaesthesiology, thus, will monitor the vital signs during the procedure and play a key role in patient safety.

Very rare cases of heart attack, stroke, and excessive bleeding happened in the outpatient setting. But some patients may require hospital admission following surgery.

 

• Stress relief for family and home care providers

For paediatric patients, the elderly and patients with mental illness, we highly recommend ambulatory surgical procedures if their condition allows the day surgery treatment which lasts for several hours or half day. They can return home and receive a better postoperative care when the surgery is completed. Their family members or home care providers can also get a relief while caring for the patient at home.

 

• Cost savings

The emerging day-case surgery centres in Hong Kong, on the other hand, can effectively reduce the significant pressure of healthcare resource allocation on public hospitals. Moreover, day procedure services charge less than private hospital setting without high costs of hospital expenses, meals, and miscellaneous items. Day surgeries allow more patients who need urgent care to have scarce health care resources. A patient should expect medical expenses to triple or quadruple for colonoscopy and gastroscopy performed in the General Ward instead of in an outpatient setting. In recent years, day surgeries have been covered by most health insurance plans that can help reduce the financial stress resulting from treatment costs. And most day surgery centres provide fixed-price and all-inclusive medical packages that enable the patients to know about budgeting in an easier way.

 

• Enhance the Operation Theatre Efficiency

Patients who do not require emergency attendance can seek needed outpatient care or undergo minor surgeries in a Day surgery centre. Day surgery can reduce the hospital occupancy rate and achieve better allocation of limited medical resources to the citizens. Patients who are undergoing the day endoscopy, i.e. colonoscopy, gastroscopy, and some minor operations, are expected to go home the same day as the procedure.

 

• Reducing the burden of the public sector

Day surgery services can alleviate the burden of inpatient facility and resource utilisation, including manpower shortage of medical professionals, operation theatre utilisation and bed occupancy rate. And finally, we can provide the limited healthcare resources of public hospitals to patients in emergency situation or with severe conditions.

In some overseas day surgery centres, patients can make a booking for a procedure with a lower cancellation rate. It helps make full use of the healthcare resources and medical facilities.

 

 

How Can I Define A Qualified Day Surgery Centre?

• Patient experiences

This entire experience of a patient includes making outpatient appointment, having surgery, recovering after anaesthesia, and receiving clinical support services. The well-trained medical staff are more focused on patient education, help them recover in a calm and restorative environment supported by the best possible care, and enhance the patient safety and comfort during the treatment.

 

• Facility management

Day surgery centres are now introducing cutting edge medical technologies apart from the standardised surgical apparatus. With the improved surgical instruments, the day surgery centre is able to have more complex medical problems being solved. Regular maintenance will be performed to ensure the safety of the operating theatre or treatment rooms reach international standard. A qualified day surgery centre place the patient’s experience as the top priority and will provide a private resting room for each patient and their family.

 

• Clinical performance

A qualified day surgery centre should have greater control over procedures and standards. They usually set the standards for staffing, safety precautions, postoperative care, etc. to help patients regain consciousness quickly and completely after the surgery and better control the complications, such as nausea and vomiting, dizziness, and postoperative pain. The medical staff are committed to making day surgery become a safer and convenient option for the public.

 

The ambulatory surgery is now expanding throughout the world and it is increasingly common for day case procedures. Government has stated stricter regulations for the day surgery centre concerning both the hardware and service quality. The improvement of day surgery centre can reduce patients’ waiting time at present in the public hospital. A qualified day surgery centre embraces high calibre staff, essential medical supplies, standard operating procedures, cost transparency, and expanding service scope of day surgery. The centre is always committed to providing patient-centred care, identifying the safety at every level of medical services, and benefiting our citizens by a comprehensive range of day surgery procedures.

 

Reference:

Census and Statistics Department, The Government of the Hong Kong Special Administrative Region. (2018). Population. https://www.censtatd.gov.hk/hkstat/sub/so20.jsp

Hospital Authority. (2018). Waiting Time for New Case Booking at Surgery Specialist Out-patient Clinic. http://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=214197&Lang=ENG&Dimension=100&Parent_ID=10053&Ver=HTML

The Hong Kong Federation of Insurers (HKFI). (2017). Hong Kong people took out medical insurance against soaring medical fees. https://www.hkfi.org.hk/#!/media-release/420

YC Lee, PP Chen, Jacqueline Yap, Patricia Yeo & Christopher Chu. (2007). Attitudes Towards Day-Case Surgery in Hong Kong Chinese Patients. Hong Kong Med J 2007;13:298-303.

https://www.surgeryencyclopedia.com/A-Ce/Ambulatory-Surgery-Centers.html#ixzz5gX24BxWd

https://academic.oup.com/bjaed/article/14/6/256/247587

https://www.emedicinehealth.com/outpatient_surgery/article_em.htm#for_more_information_on_outpatient_surgery