Day surgery: how far can we go and are there still any limits?

Abstract

Day surgery continues to be a popular form of care, and patients and procedures of ever-increasing complexity are now being considered. As previous restrictions are regularly swept away, it is reasonable to ask where the new limits are and whether there are still any absolute contraindications to day surgery. Recent evidence provides confirmation that some of the more complex, minimally invasive surgical procedures, such as laparoscopic nephrectomy, can safely and successfully be undertaken on a day-case basis. This transformation is clearly dependent on the development of appropriate technologies, but also involves a realistic assessment of when complications will occur and whether or not these will be prevented by an overnight hospital stay. A similar approach can be applied to the impact of various medical comorbidities, with current evidence suggesting that many predict intraoperative, but not postoperative, complications. The interactions of various factors -medical and surgical - however, may be more important. Day surgery has clearly expanded beyond its previous limits, but some absolute contraindications still remain. A great deal is possible, but not everything that can be done necessarily benefits patients and some cases may only be feasible in expert hands and in ideal conditions.