Elsevier

The Foot

Volume 19, Issue 2, June 2009, Pages 101-106
The Foot

A report of UK experience in 917 cases of day care foot surgery using a validated outcome tool

https://doi.org/10.1016/j.foot.2009.01.002Get rights and content

Abstract

Background

Day case surgery is an increasingly important treatment modality and one that foot surgery is particularly well suited to.

Objectives

This article presents an in depth evaluation of the outcomes of day case foot surgery undertaken in the primary care setting.

Method

917 consecutive day surgery cases were evaluated with the Foot Health Status Questionnaire (FHSQ), patient satisfaction questionnaires and complication audits.

Results

917 separate day care admissions were audited (696 females and 221 males). The average age at time of surgery was 50 years (range 14–100, S.D. 11). Post-operative follow up was usually complete by 26 weeks (range 21–218 weeks, S.D. 145). A total of 2772 individual procedures with patients receiving between one and five procedures per admission. The majority of patients (81%, N = 743) opted for local anaesthesia. The FHSQ scores for foot pain, foot function, foot health, shoe fitting, general health, physical activity, social capacity and vigour improved. Patient satisfaction results were favourable and complication rates were within acceptable limits.

Conclusions

Podiatric surgery is well placed to meet both the demands of government and patients in delivering a high quality, safe and efficient treatment for patients requesting elective surgical intervention for foot deformity.

Section snippets

Background

Day surgery is not a new concept and today in the UK more than 60% of patients have elective surgery as day cases whereas the figure reaches 70% in the USA [1]. This is compared with only 15% of elective surgeries in the early 1980s [2]. The shift towards day surgery has been a gradual one and the concept can perhaps be traced back to 1910 when Dr Nicoll reported the results of operating on sick children in Glasgow [2], [3], [4], [5]. The revolution in surgical practice through the 20th century

Objectives

This paper will present the experience and results of 917 episodes of community day care surgery in a Podiatric Surgery department over a 4-year period. The paper will concentrate on several key aspects of patient care; satisfaction as determined by outcome measures, anaesthetic choice, pain management and complications.

Method

A standard protocol was introduced within the Solihull Care Trust department of Podiatric Surgery to evaluate surgical outcomes in all NHS cases. Ethics approval was obtained locally for the implementation of a patient administered audit tool in conjunction with a perioperative and post-operative complication audit and post-operative patient satisfaction survey.

Audit data was collected between 01/01/2004 and 18/01/2008. All patients attending the department of Podiatric Surgery who subsequently

Results

Study data was collected between 01/01/2004 and 18/01/2008. During this period 917 consecutive foot surgery day care admissions were audited (696 females and 221 males). The average age at time of surgery was 50 years (range 14–100, S.D. 11). Post-operative follow up was usually complete by 26 weeks (range 21–218 weeks, S.D. 145) at which point the patient was discharged from the service. The 917 admissions resulted in a total of 2772 individual procedures with patients receiving between one

Discussion

Day care surgery is a now an accepted and popular choice for patients, service providers and government [1], [11], [24]. Day surgery may be provided with either general or local anaesthesia. General anaesthesia is typically only available in acute hospitals and requires a considerable staffing resource input in terms of the anaesthetic team and recovery team.

The use of local anaesthesia is a significant clinical and economic consideration when planning for and managing a day care service. The

Conclusion

Day care surgery is an increasingly important treatment modality. Day care treatment is seen as cost effective by government and health service managers while patients are attracted to the same day discharge and the presumed rapid recovery. Patients also appreciate the choice of anaesthesia and the majority appear to prefer local anaesthesia when it is available.

Podiatric surgery is well placed to meet both the demands of government and patients in delivering a high quality, safe and efficient

Conflict of interest

None of the authors of the attached article gained any financial benefit or other reward through the production of this manuscript. The authors have no relationship with the manufacturers of any products described within the manuscript. No grants or external funding were sort or received.

Acknowledgment

Mr Michael Hutchby FCPodS, for assistance with data preparation, illustrations and collection of audit data.

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