Day-case septoplasty: a default pathway or is case selection the key?

Abstract

Septoplasty has been identified as suitable for day surgery, but is not commonly performed as such. Guidelines for day surgery stipulate that the unexpected re-admission rate should be 2–3 %; however previous studies have not attained this target. The purpose of this study was to ascertain the surgical and patient factors associated with re-admission following day-case septoplasty. A retrospective case-notes analysis of day-case septoplasties between 1 January 2010 and 31 December 2012 was undertaken. Data on patient demographics, surgeon grade and operative technique were examined using a univariate analysis model. A total of 256 septoplasties were performed. 23 patients were admitted, overwhelmingly due to bleeding in the immediate post-operative period, giving an overall admission rate of 9.0 % within the first 24 h. Factors associated with re-admission included the use of intranasal splints (relative risk (RR) 5.34, p < 0.001), the performance of additional operative procedures (RR 4.96, p < 0.001) and surgery on patients with co-morbidities (RR 3.37, p = 0.002). There was no correlation between unexpected admission and patient gender, age, surgeon grade, performance of revision surgery and operative factors including nasal preparation with cocaine, local anaesthetic infiltration, type of incision, number of mucoperichondrial flaps raised, extensive bony dissection, performance of a turbinate procedure, quilting, closure of incision and post-operative packing. Day-case septoplasty in patients with co-morbidities and where additional surgical procedures are performed may be associated with unexpected overnight admission. Thus, safe and efficient day-case septoplasty may not be suitable as a universal default pathway but one where case selection is key.