Evaluating the development of a one day surgery system of the anesthesia department, Charoenkrung Pracharak Hospital

Abstract

Objectives: To evaluate the development of a One-Day Surgery (ODS) system in the anesthesia department at Charoenkrung Pracharak Hospital, focusing on postoperative complications, incidence of unplanned admission, readmission within 24 hours, surgical postponement or cancellation, patient satisfaction, and factors associated with unplanned admission.

Materials and Methods: A retrospective descriptive study was conducted on 477 patients who underwent nine pilot ODS procedures and received anesthesia services between October 1, 2022, and September 30, 2023. Data were collected from medical records and the One Day Surgery & Minimally Invasive Surgery registry (ODS & MIS). Descriptive statistics and multiple logistic regression analyses were used for data analysis, with statistical significance set at p<0.05.

Results:The mean age of the patients was 55.92 ± 15.12 years. Most patients were classified as American Society of Anesthesiologists (ASA) physical status II (73.40%) and had comorbidities (57.23%). Total Intravenous Anesthesia (TIVA) was the most commonly used anesthetic technique (80.70%). Postoperative complications included severe surgical site pain (pain score > 6) in the recovery room (6.92%), nausea and vomiting (1.89%), urinary retention prior to discharge from the recovery room (20.34%), and wound bleeding (0.42%). The incidence of unplanned admission was 1.68%, and readmission within 24 hours occurred in 0.21% of cases. No surgical postponements or cancellations were observed. Multivariate logistic regression analysis revealed that the loop electrosurgical excision procedure was associated with a significantly higher risk of unplanned admission compared with colonoscopy (adjusted OR = 48.31, 95% CI: 3.89-599.43, p = 0.003). Overall patient satisfaction with anesthesia services was rated at the highest level (mean score 4.97-4.99).

Conclusion: The one-day surgery system in the anesthesia department demonstrated safety, effectiveness, and high patient satisfaction. Strict adherence to pain management protocols and development of post-discharge follow-up systems should be implemented to continuously enhance quality of care.