Safety of day‐case endoscopic sinus surgery in England: An observational study using an administrative dataset

Abstract

Introduction: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for endoscopic sinus surgery (ESS). The aim of this study was to investigate the safety of day-case ESS in England.Design: Secondary analysis of administrative data.Methods: We extracted data from the Hospital Episodes Statistics database for the 5 years from 1 April 2014 to 31 March 2019. Patients undergoing elective ESS procedures aged ≥17 years were included. Exclusion criteria included malignant neoplasm, complex systemic disease and trans-sphenoidal pituitary surgery. The primary outcome was readmission within 30 days post-discharge. Multilevel, multivariable logistic regression modelling was used to compare outcomes for those operated on as day-cases and those with an overnight stay after adjusting for demographic, frailty, comorbidity and procedural covariates.Results: Data were available for 49 223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day-case surgery varied from 20.6% to 100%. Nationally, rates of day-case surgery increased from 64.0% in the financial year 2014/2015 to 78.7% in 2018/2019. Daycase patients had lower rates of 30-day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). Outcomes for patients operated on in trusts with ≥80% day-case rates compared with patients operated on in trusts with <50% rates of day-case surgery were similar.Conclusions: Our data support the view that ESS can safely be performed as daycase surgery in most cases, although it will not be suitable for all patients.

Unwarranted variation and the goal of net zero for the NHS in England: exploring the link between efficiency working, patient outcomes and carbon footprint

“…Day-case surgery should be the default model for low complexity procedures and be offered to all patients unless there is a clear contraindication. There is substantial unwarranted variation in day-case rates across NHS hospital Trusts in England, despite evidence that day-case surgery is safe for carefully selected patients [15][16][17][18]. Recent modelling performed by the GIRFT programme and Greener NHS found that progressive increases in the rates of day-case surgery performed for transurethral resection of bladder tumour (TURBT) surgery has saved 20.9 million kgCO 2 e over 9 years (2013/2014 to 2021/2022), and further adoption of day-case surgery could reduce carbon emissions by a further 217,599 kgCO 2 e (based on 2021/ 2022 data [19]).…”

“…These included a reluctance to change current practice; lack of day‐case infrastructure; concern that outcomes would be compromised; and belief that day‐case rates were already ‘optimal’. Despite clear progress at a national level with recent increases in rates of day‐case surgery across a range of procedures and specialties [15–18], rates vary considerably by Trust, hospital and surgical specialty. In addition, rates of conversion from day‐case to inpatient stay vary from 3% to 39% across Trusts in England [13].…”

Delivering a net zero National Health Service: where does otorhinolaryngology – head and neck surgery stand?

“…No superiority of in-patient stay was demonstrated in terms of patient outcomes or readmission rates. 12 Operating theatre CO 2 equivalent emissions…”