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Clinical practice and routines for day surgery in Sweden: results from a nation‐wide survey
Author(s) -
SEGERDAHL M.,
WARRÉNSTOMBERG M.,
RAWAL N.,
BRATTWALL M.,
JAKOBSSON J.
Publication year - 2008
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2007.01472.x
Subject(s) - medicine , ambulatory , nausea , vomiting , analgesic , general anaesthesia , telephone interview , anesthesia , postoperative nausea and vomiting , emergency medicine , surgery , social science , sociology
Background: Day surgery has expanded considerably during the last decades. Routines and standards have developed but differ between and within countries. Methods: We studied the practice of day surgery in Sweden by an extensive questionnaire survey sent to all 92 hospitals. Results: The proportion of day surgery vs. in‐hospital procedures was overall 43%, with 43% in adults and 46% in children. Orthopaedic (33%), general (29%) and gynaecological (17%) surgery were the most common ambulatory procedures. Most patients (>90%) underwent pre‐operative assessment by an anaesthesiologist. Patient self‐assessment questionnaires were common (86%). Risk stratification for post‐operative nausea and vomiting was used by 70% of the departments. Anxiolytic pre‐medication was uncommon. Most anaesthesiologists (95%) used pre‐operative oral analgesics to initiate post‐operative analgesia, the most common being paracetamol (95%), NSAIDs (73%) and coxibs (15%). A balanced general anaesthesia technique was preferred. Post‐operatively, 93% of the units routinely assessed patients' pain. Analgesic combinations of paracetamol, NSAIDs and weak opioids were used by 94% of the units. Most hospitals (80%) had standardised discharge criteria based on clinical assessment, and many required a patient escort at home for 24 h post‐operatively. Assessments of unplanned admission, re‐admission and post‐operative complications were not performed routinely. Follow‐up telephone calls within 1–2 days were performed regularly in about 40% of the units, or in selected patients only (37%). Pain was the most frequent complaint on follow‐up. Conclusions: In Sweden, a high degree of standardised regime for day surgical practice was found. Post‐operative pain is the most common complaint after discharge.