Day surgery for children

Abstract 

Children are excellent candidates for day-case management as most are healthy and require minor or intermediate surgery of short duration. The cost-effectiveness of day surgery is particularly attractive to healthcare providers, and consequently the UK government have declared that at least 50% of elective children’s surgery should be performed as day cases. Day-case management is also advantageous for children and their families. The psychological impact of hospital admission is avoided, hospital-acquired infection is minimized and disruption to family routines lessened. A successful paediatric day-case service minimizes postoperative morbidity and has low inpatient admission rates. Good-quality anaesthesia is essential for achieving these goals, along with an experienced multidisciplinary team working in child-friendly surroundings. Scrupulous attention to perioperative symptom control (particularly pain and vomiting) is essential for successful day surgery. The child at risk of postoperative nausea and vomiting should be identified and treated with prophylactic anti-emetic medication. Post-discharge analgesia should be prescribed regularly rather than as required to optimize pain control. Children may be discharged when their vital signs are stable, pain and nausea are well controlled and there are no surgical concerns.

Keywords: day surgery, discharge criteria, exclusion criteria, paediatric anaesthesia, preoperative preparation