Randomized clinical trial of the effectiveness of emergency day surgery against standard inpatient treatment

Background: The aim of this study was to assess the feasibility of treating patients with minor and intermediate general surgical emergency conditions as day cases. Methods: Emergency referrals for minor and intermediate general surgical conditions were assessed by a surgeon. Those fitting day-ease criteria and requiring operation under general anaesthesia were randomized to receive standard inpatient care or day surgery. Patients in the latter group were booked on to day-case lists or gaps on inpatient elective lists for surgery within 48 h. The process was coordinated by an experienced theatre sister. Results: One hundred patients were randomized. There was a reduction in the number of nights spent in hospital in the day-case group (median 0 versus 2 nights; P < 0.001). The median time from diagnosis to treatment was 1 day in both groups, although there was a small but significant delay in the day-case group (P = 0.018). There was no significant difference in postoperative outcome or patient and general practitioner satisfaction. The day-case option had no increased impact on primary care services but was associated with a significant salving of about pound150 per patient (P < 0.001). Conclusion: Certain general surgical emergencies may be managed as day cases with cost saving but without detriment to patient care.