Three years of institutionalized paediatric day case surgery: organization — indications — frequency — complications

Abstract

In the last seven years, the number of surgical procedures which are performed as day case surgery for infants and children has increased dramatically. Day case surgery should be able to be conducted effectively, with few complications, while saving time and money but also providing a pleasant atmosphere for the children and their parents. Since 1990, we have been practising day case surgery in the Department of Paediatric Surgery at the University of Tübingen twice a week. We have a special unit for this purpose with a team of day care personnel, paediatric nurses, anaesthesiologists and paediatric surgeons. The total number of operations performed in our department from 1990 to 1992 was 5330. Of these, 2111 (39.6%) were conducted as day case surgery for children of the ages six weeks to 20 years. The series includes 44 umbilical hernias, 385 phimoses, nine cervical cysts, 399 inguinal testes, 857 inguinal hernias, 90 hydroceles/funiculoceles, 19 haemangiomas, 43 meatotomies, 95 endoscopies and 170 other operations. Postoperative complications were defined as secondary haemorrhage, fever, obvious vomiting and urine retention. In a total of 35 (1.66%) children, the complications necessitated a stay in the hospital of up to eight (average 2.17) days, despite day case planning of the surgical procedure. Our experience shows that a large number of paediatric surgical procedures can be performed as day case surgery. Nevertheless, even with an expanded spectrum of possible operations there must always be ward capacities available in order to monitor and treat complications adequately.