Dear doctor,

I have recently been diagnosed with a gynecological condition that requires minor surgery. A hospital admission has been arranged for 2 days, but I wondered why I wasn’t given the choice of day-care surgery? 

Ongoing advances in gynecological surgery mean that there is less and less need for admitting women in hospitals. So much can be done in out-patient settings compared to times gone by. It means being operated and discharged on the same day, ending up spending less than 24 hours in the hospital. The default should be to have as much care done in day centres, and only reserve hospital admissions for complex procedures that require intense observations over a few days. 

Your safety comes first when any surgical procedure is planned. You must tick several boxes in order to qualify for day care surgery. For starters, your operation must be deemed appropriate for day care, and unlikely to be prolonged or prone to complications. Such judgment is not the sole prerogative of your surgeon alone, but your anesthetist as well. You must already be healthy in other respects, best not to suffer from other chronic illnesses, like diabetes for example. You may sometimes be asked to do some tests to support suitability for day care surgery. 

Once day care surgery is planned, you get admitted on the same day that surgery will be done. You will have been given specific instructions in preparation for the surgery. At completion, you get kept in an observation area for a few hours. Again an assessment is done just prior to your discharge, in attempts to confirm safety of immediate recuperation at home. You get to go away with a further set of instructions, and trigger points for initiating return to hospital should certain events occur.  

Day care surgery has several advantages. You get spared from potential ills that can befall those that get admitted, like hospital acquired infections for example. You get to recuperate in familiar surroundings, and with your family. It also costs much less, both for you and your insurance. The hospital also makes quite some savings; ranging from the cost of healthcare staff, to costs associated with accommodation. More hospital beds can then be spared for deserving cases.

 Your gynecologist must have made a reasoned judgment about your suitability for day care surgery. But you could also have sought an explanation as to why day surgery was not offered. It may be that your operation appeared simple, but may have had some complexity in other ways. Perhaps the day care set-up where your doctor operates is not ideal. Or maybe your doctor is not too confident operating on a day care basis. Nevertheless, the default should always be to avoid hospital admissions. Modern gynecological care renders itself optimal for out-patient settings. 

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