Day case surgery
Day case surgery: challenges and opportunities
The Fifth Annual Operating Theatres Show 2025 took place earlier this year at the Kia Oval. Organised by the Institute for Government & Public Policy, high on the agenda was the need to ‘think day case first’, to further the recovery of elective surgery.
Patient backlogs persist as a significant challenge in the NHS, with over 7 million people on a hospital waiting list in England. Improving efficiency and theatre productivity to reduce elective long waits and backlogs has never been more critical. While significant progress has been made in terms of expanding day surgery, there remains further opportunity to increase and broaden day case surgery across the UK. As part of national efforts to get to grips with the elective recovery, Trusts are being encouraged to ‘think day case first’. With this in mind, the Getting It Right First Time (GIRFT) programme has worked in collaboration with the British Association of Day Surgery (BADS) and the Centre for Perioperative Care (CPOC) to update its guidance to support Trusts and systems to maximise the use of day case surgery.1 This approach offers clear benefits for patients, staff and services, as David Bunting, President of the British Association of Day Surgery (BADS), pointed out during his presentation at the Annual Operating Theatres Show. Discussing the opportunities and challenges
around day case surgery, he explained that the benefits include: a shorter stay in hospital and enhanced patient experience – patients report that they prefer to recover from surgery in the comfort of their own home. Day case surgery patients also experience fewer post-surgery complications i.e. bleeding, blood clots and infections, while the benefits for Trusts include cost savings and the fact that day surgery frees up beds for other patients – such as cancer patients and high acuity admissions, for example. Day case surgery also increases hospital patient flow, reducing the pressures on the emergency department and reducing waiting lists. Finally, day surgery is seen as key to improving surgical sustainability – 6%-7% of greenhouse emissions come directly from healthcare and over a half of these emissions are from inpatient care.
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Defining day case surgery Day case surgery in the UK is defined as a planned admission for a procedure with a discharge on the same calendar day. David Bunting explained that it “does not include the 23-hour definition”, which is often used overseas – particularly in the US and China. The main intent must be ‘day case surgery’, in order for the procedure to be captured as a ‘day case’ procedure by NHS data systems. Even if the patient is booked for an overnight stay, and happens to go home on the same day, this “doesn’t count as a day case,” he commented. “This is not the only reasons why it is important for the patient to be booked as a day case, as the intended management. If the patient is booked with an overnight stay and one isn’t available, the surgery gets cancelled and it increases the surgery cancellation rates,” he continued. “If a patient goes to an inpatient bed, in an inpatient ward, there is much more of a likelihood of an overnight stay.
Quality in day case surgery He commented that there are three measures of day case surgery quality – effectiveness (i.e. how many procedures are being performed as day case), efficiency (i.e. throughput and productivity) and safety (i.e. whether there are any complications). “There is no evidence that doing a procedure
as a day case, compared to an overnight stay, relates to any increase in complications. To measure performance, we need a benchmark,” David Bunting commented. He explained that BADS produces a Directory
of Procedures which provides recommended day case rates for nearly 300 surgical procedures, arranged by specialty and defined using OPCS (Operating Procedure Codes Supplement ) coding. The rates quoted are arrived at by a combination of reported practice from leaders in their field, actual rates from Hospital Episode Statistics figures and expert opinion, and most are achieved by one or more
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