Day Surgery: A Systematic Overview

Duration: May 2012 - December 2012
Publication: HTA-Project report No 64: https://eprints.aihta.at/987

Language: German

Background:
In countries like Canada, the USA, the UK or Scandinavia it is usual for years to treat patients as day surgery cases. In Austria day surgery is not very common. Because of shorter waiting lists, major inpatient offers and a different situation of incentives.
There are some special per-case flat rates in the Austrian hospital benefit catalogue for day surgery performances. But in an international comparison, the number of day surgery cases in Austria is very low.

Aims of project:
To compare the existing evidence of efficacy, safety and (direct) costs of day surgical and inpatient operations. The evaluation is mainly focusing operations which are very common in Austria and can be performed in an inpatient and outpatient way. These described performances are:
• cataract operation
• curretage
• arthroscopic operation of the knee
• operation of varicosis
• cholecystectomy
• adenotomy (and tonsillectomy)
• paracentesis
• decompression of nervus medianus
• closure of inguinal or femoral hernia
• removal of bone implants (lower extremety)
• appendectomy

Research objectives:
• Which evidence for efficacy, safety and costs of named day surgical performed operations (in comparison with inpatient surgery) is available?
• Which indications and contra-indications (national and international) exist for named operations for performing them in an outpatient way?
• Are there any restrictions for indications of performing outpatient operations?
• For which conditions (e.g. structural, personal, financial, etc.) the different surgical interventions are performed in- or outpatient?

Methods:
• 2-step systematic literature search
• Step 1:
- systematic literature search in different databases (Pubmed, The Cochrane Library, Medline via Ovid, NHS-EED-DARE-HTA)
- non-systematic handsearch
• Step 2 (in case of no results of step 1):
- search for country reports and guidelines and sources of evidence for their decision to perform some operations as day surgical

Inclusion criteria (step 1 and 2):

Populationmen and women (?18 years)indications:a) cataractb) bleeding irregularities, miscarriage, neoplasia of uterus, etc.c) rupture of knee ligament / cruciate ligament / meniscus d) varicose / varices e) gallstone / cholecystitis / cholesterol polyp / gall bladder cancer f) tonsillitis / adenitis g) eustachian catarrh or sinusitis h) carpal tunnel syndrome i) inguinal and femoral hernia j) implanted devices in bone k) appendicitis Interventionoutpatient treatment for:a) cataract surgery b) curettage/ excision of endometrium in uterus c) arthroscopic operations of knee d) vein ligation / stripping e) cholecystectomy laparoscopicf) adenoidectomy / tonsillectomy g) paracentesish) carpal tunnel decompression of median nerve i) repair / operation / surgery of inguinal and femoral hernia j) removal of implanted devices from bone k) appendectomy Controlinpatient treatment for the same indications / interventions (a-k)Outcomesefficacy- reoperation rate - (re)admission in hospital / duration of hospital stay - quality of life - symptoms safety- mortality - postinterventional infections - bleeding - pain costs- direct medical costs - direct non-medical costs - indirect costs Study designs: - systematic reviews- primary studies:     - randomized controlled trials      - non-randomized, controlled, prospective trials - cost studies and economic evaluations: cost-effectiveness studies, cost-utility studies, cost-minimisation studies - health services research studies - uncontrolled studies - retrospective studies / data evaluations - case series

Exclusion criteria:
• editorials, letters to the editor, comments, etc.
• case reports, opinions of experts
• study protocols
• animal studies , in-vito studies
• feasibility studies
• published before 2002
• not German or English