Good day surgery requires high-quality anesthesia

Day surgery was first proposed by English pediatric surgeon Nicoll in 1909, and American Dr. Waters started adult day surgery at the same time. Although the concept of day surgery varies in the world, it generally refers to a surgical model in which the patient is admitted, operated on, and discharged within one working day (24 hours), excluding outpatient surgery performed in clinics or hospitals.

Day surgery has the advantages of increasing bed turnover, shortening hospital stay, improving the efficiency of medical resource utilization, and reducing hospitalization costs. With the advancement of surgical technology, the rise of minimally invasive surgery, the development of anesthesiology, and the improvement of medical management capabilities, day surgery has developed rapidly in developed countries and has become a safe, efficient, and economical surgical management model. In many developed countries, the proportion of day surgery has reached more than 70%-80%.

my country began to carry out day surgery in the early 21st century. In recent years, the number of day surgeries in China has increased rapidly. In 2019, China performed 1.45 million day surgeries, accounting for 13.2% of elective surgeries. In 2019, the proportion of day surgeries to elective surgeries was included in the performance evaluation system of tertiary public hospitals of the National Health Commission, marking a new stage in the development of day surgery in my country.

Day surgery should be equipped with the medical resources needed for day surgery, including relatively fixed day surgery rooms, post-anesthesia recovery rooms, medical beds, equipment and facilities, and medical staff. At present, the management model of day surgery patients varies from hospital to hospital. Some hospitals have centralized admission and centralized management, while others have decentralized management with some beds provided by various departments. In general, as long as it can ensure the safety of patients during the perioperative period, it is a good model.

All tests and examinations of the patient should be completed before surgery or even before hospitalization, and the corresponding anesthesia evaluation should also be performed in the outpatient clinic. Anesthesia methods include general anesthesia, local infiltration anesthesia, nerve block anesthesia, etc. In most cases, spinal anesthesia (common people call it semi-anesthesia) is not the first choice because spinal anesthesia may cause motor blockade of the lower limbs for several hours, and complications of spinal anesthesia may appear after a few days. Most patients are required to fast for eight hours and not drink for two hours before anesthesia. We also recommend that patients chew gum before and after surgery, which is beneficial to the patient's gastrointestinal motility and reduces the chance of postoperative nausea and vomiting.

At present, there are more than 700 types of day surgery procedures recommended in my country, involving many disciplines. Our hospital has also carried out some intraoperative surgeries, and preoperative examinations and tests can be partially reimbursed locally, which is highly recognized by local patients. So whether the patient can undergo day surgery or can only undergo ordinary hospitalization surgery still requires further evaluation by the doctor!

Department of Anesthesiology, Huanghua People's Hospital, Hebei Province, Shen Haiyang

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