Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Lawrie F (1), Chu M (1), Lam V (1)
Affiliation :
(1) Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
The popularity and prevalence of day-surgery are growing globally, as patients and hospitals alike are recognising the many benefits. More complex and co-morbid population are now considered eligible for day surgery; for many of these patients, spinal anaesthesia (SA) is a safer alternative to general anaesthesia (GA). In the UK and Europe, short-acting local anaesthetics (LA) (with time to recovery < 1 hour) are now available and widely recommended for day-surgery patients. In Hong Kong, however, these short-acting LA are not available. This has generated concerns that patients may be unable to fulfil discharge criteria (including complete recovery of power and sensation) in time for same-day discharge.
Objectives :
(1) To determine whether the use of SA in day-surgery has an effect on successful same-day discharge. (2) To seek any potentially modifiable factors which may influence discharge success. (3) To compare our provision of SA in day-surgery patients with international recommendations.
Methodology :
A one-year retrospective analysis was conducted on patients undergoing day-surgery in PYNEH. Inclusion criteria encompassed surgeries where either SA or GA was clinically suitable. Patients < 18 years of age and pregnant women were excluded. Data were retrieved from CMS and Department Day-surgery forms.
Result & Outcome :
A total of 283 patients were analysed—102 (36%) received SA and 181 (64%) received GA. Failed discharge occurred in 11/102 (10.8%) of patients who received SA and 24/181 (13.3%) of patients who received GA. There was no statistically significant difference between the two groups. The anaesthesia commencement time was the only factor influence the discharge success; those with anaesthesia commencing before 10am had a 5.1% chance of failed discharge, compared to a 31.1% if started at or after 2pm.
Notably, our practice of SA deviated significantly from British Association of Day Surgery (BADS) and Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines, primarily due to the unavailability of recommended local anaesthetics in the region.
Conclusion
SA and GA are equally effective in facilitating same-day discharges for day-surgery patients. The inavailability of short-acting LA is our primary barrier to aligning our practice with international recommendations. Standardised SA technique and clearer protocols for discharge after SA would also improve the quality and safety of our service.
