Another approach to the hernia waiting-list

Early discharge after operation

To assess the feasibility and advantages of short-stay surgery in India, a policy of early discharge was adopted for 386 patients undergoing various major and minor operations. The mean postoperative and total hospital stays of patients admitted for minor surgery were 1.9 and 3.7 days respectively; the corresponding figures for age- and sex-matched historical controls were 7.4 and 11.3 days. The mean postoperative and total stays of patients who had undergone major surgery were 4.1 and 8.0 days respectively; the corresponding control values were 8.9 and 12.5 days. The use of absorbable subcuticular skin sutures helped to shorten postoperative hospital stay and avoided an extra follow-up visit. The overall complication rate in the study group was 9.6 per cent and in historical controls 13.4 per cent (P > 0.05). A total of 2357 hospital bed-days were saved during the study and 95.6 per cent of patients approved of short-stay surgery.

Postoperative analgesia for day-case herniorrhaphy patients. A comparison of cryoanalgesia, paravertebral blockade and oral analgesia

Patients were admitted as day-cases for inguinal herniorrhaphy under epidural anaesthesia and chlormethiazole sedation. The patients were given oral analgesia, and in addition, some were given either a paravertebral block with a dextran/bupivacaine mixture or cryoanalgesia of the ilio-inguinal nerve for postoperative pain relief. These anaesthetic and analgesic techniques are discussed in relation to day-case herniorrhaphy.

Day care after operations for hernia or varicose veins: a controlled trial

Alternative systems of care after operations for varicose veins or hernia were compared in a total of 360 selected patients, of whom 121 were allocated to be managed in an acute ward for 48 h, 122 in a convalescent hospital for 48 h and 117 to be discharged directly home to the care of the district nursing sister and general practitioner. There were no deaths or major complications. Anaesthetic or surgical problems caused 5 patients (3 convalescent and 2 day care) to be retained in hospital on the day of operation. Minor complications were recorded in approximately one-third of the patients. The majority of these were effectively dealt with by the district nursing sister and only one-third of the complications needed the attention of the general practitioner. Two of the ward patients and 1 of the convalescent patients required readmission to hospital (1 per cent in all). No significant difference was demonstrated in the medical outcome between the three groups after operation. Day care was the most economical of the three systems of care. Inquiry into the patients' opinions elicited the highest proportion of favourable responses in the day care group.

Day care and short stay surgery for hernia

The duration of postoperative stay has been falling in recent years as more conditions are considered suitable for outpatient care. The introduction of short stay surgery not only relieves hospital waiting lists but also represents an economic advantage and has certain social benefits for the patient. The treatment of more patients as day cases reallocates the workload, putting increased responsibility on to outpatient clinics and general practitioner and community services. It also demands careful consideration of in-hospital operative and anaesthetic techniques to speed recovery and minimize complications.

One hundred and eighty-seven cases of child abuse and neglect

The case histories of 187 abused and neglected children, admitted to the Royal Alexandra Hospital for Children over a three-year-period, were reviewed. Multiproblem families from the lower socioeconomic groups predominated, reflecting the hospital's geographic catchment area. Eight children died and 30 were made state wards. A high proportion of mothers described problems during the pregnancy, a difficult delivery and neonatal problems. The majority of parents in this study were married and had small families. First-born male infants of young isolated mothers were found to be at greatest risk of child abuse and neglect.