Day-case septoplasty and unexpected re-admissions at a dedicated day-case unit: a 4-year audit

Introduction Septal surgery has been identified as suitable for day-surgery, but is not widely performed as such. Guidelines for day-surgery state that the unexpected admission rate should be 2-3%. Previous audits have not achieved this figure and septoplasty is not universally considered suitable for day-surgery. We have reviewed practice over 4 years in our institution to identify surgical and patient factors associated with unexpected admission following septoplasty. Patients and Methods A retrospective case note based audit of day-case septoplasty procedures reviewed at the end of each year between October 1998 and October 2002. Results A total of 432 septal surgery procedures were performed, comprising 378 septoplasties and 54 submucous resections. Thirty-eight patients were admitted, overwhelmingly because of haemorrhage in the immediate postoperative period, giving an overall admission rate of 8.8% within the first 24 h. Factors associated strongly with re-admission were the use of intranasal splints, the performance of revision surgery, submucous resection (as opposed to septoplasty) and, less so, the performance of additional procedures and the peri-operative administration of diclofenac. There was no correlation between unexpected admission and grade of surgeon, surgical technique or any of the patient factors analysed. Conclusions The unexpected admission rate of septal surgery performed at our unit is above that recommended for day-case procedures, but is within the range previously published. Patient satisfaction with day-case septoplasty has been shown to be high. We believe that septoplasty should be performed in this setting but there is a significant chance that patients may need admission, and a pathway should be in place for this to occur with minimal disruption to the patient.