Copyright
©The Author(s) 2023.
World J Orthop. Apr 18, 2023; 14(4): 248-259
Published online Apr 18, 2023. doi: 10.5312/wjo.v14.i4.248
Published online Apr 18, 2023. doi: 10.5312/wjo.v14.i4.248
Table 1 Survey sent to British Orthopaedic Foot and Ankle Society membership list in August 2021
Question 1 |
What is your occupation? |
Open-response |
Question 2 |
In what setting do you work? Select all that apply |
Acute NHS Trust -specialist foot and ankle unit |
Acute NHS Trust – non specialist foot and ankle unit |
District General Hospital |
Community care |
Private practice |
Question 3 |
Please estimate the number of major foot and ankle procedures that your primary centre performs in 1 calendar year |
Less than 20 |
20-50 |
50-75 |
75-100 |
100-200 |
200-500 |
500-1000 |
Over 1000 |
Don't know |
Question 4 |
Please estimate what percentage of these major ankle and hindfoot procedures are performed as day case procedures |
Open response |
Question 5 |
Do you think there is potential for more of these cases to be done as day case in your own unit? |
Yes |
No |
Question 6 |
Do you follow a protocol for day case procedures? |
Yes- national |
Yes- local |
No |
Unsure |
Question 7 |
If you follow a national protocol for day case surgery, please state which one |
Open-response |
Question 8 |
Which type of anaesthesia do you offer for day case procedures? Tick all that apply |
Don't know |
Regional |
General |
Combination of GA and regional |
Specific blocks |
Question 9 |
If you use blocks, please state which |
Open-response |
Question 10 |
Do you routinely discharge day case patients with opiate/controlled drugs such as oxycodone/oromorph? |
Yes |
No |
Unsure |
Question 11 |
What post-op analgesia do you offer for day case procedures? Tick all that apply |
Don't know |
Amitriptyline |
Gabapentin |
Ibuprofen |
Paracetamol |
Codeine |
Other: Please state |
Question 12 |
Are all patients seen by physiotherapy pre-op for walking aid/ weight bearing instruction and education? |
Yes |
No |
Unsure |
Question 13 |
Are all patients seen by physiotherapist post-op (before discharge) for walking aid instruction and education? |
Yes |
No |
Unsure |
Question 14 |
Is a post-op phone call/email/text message made to the patient? |
Yes |
No |
Unsure |
Question 15 |
If yes who provides this contact? |
Open-Response |
Question 16 |
Which outcome measures are recorded for day-case patients? Tick all that apply |
pain levels using Visual Analogue Score (VAS) |
patient satisfaction, please state which measure |
complication rate and type |
MOX-FQ |
EQ-5D |
Other (please specify) |
Question 17 |
What are the barriers for day case surgery for major foot and ankle procedures in your unit? |
No provision of physiotherapist out of hours |
No anaesthetist to perform peripheral nerve blocks |
Lack of managerial support |
Out of hours support/ point of contact for patients not available |
Never done it before |
No physiotherapy input at pre-assessment |
Other: Please state |
Question 18 |
Which complications have you witnessed or heard about in major foot and ankle procedures done as a day case? Tick all that apply |
Wound healing problems |
Wound infection |
Breakthrough pain |
Patient dissatisfaction |
Unplanned readmission |
Need for further surgery |
Delayed/non-union |
Other, please state |
Question 19 |
When and how are patients first re-evaluated after discharge? Tick all that apply for |
24 h face to face |
24 h telephone call |
1 wk face to face |
1 wk telephone call |
2 wk face to face |
2 wk telephone call |
6 wk face to face |
6 wk telephone call |
Other: Please state |
Table 2 Survey results showing current practices of major foot and ankle surgeries within their centre, n (%)
Factor | Result |
Estimated number of major foot and ankle surgeries performed in 1 calendar year | Less than 100 (n = 60) (45) |
100-200 (n = 25) (19) | |
200-500 (n = 29) (22) | |
500-1000 (n = 9) (7) | |
Over 1000 (n = 2) (2) | |
Unsure (n = 7) (5) | |
Estimated procedures performed as day-case | 0-50 (n = 99) (75) |
50-100 (n = 30) (23) | |
Unsure (n = 3) (2) | |
Is there a potential for more to be done as day-case | Yes (n = 103) (78) |
No (n = 29) (22) | |
Follow a protocol for day-case | Yes Local (n = 57) (43) |
Yes national (n = 6) (5) | |
No (n = 50) (38) | |
Unsure (n = 19) (14) | |
Types of Anaesthesia offered for day-casea | Regional (n = 63) (48) |
General (n = 69) (52) | |
Combination of regional & general (n = 107) (81) | |
Specific blocks (n = 100) (76) | |
Unsure (n = 3) | |
Routinely discharge with controlled drugs | Yes (n = 34) (26) |
No (n = 85) (64) | |
Unsure (n = 13) (10) |
Table 3 Survey results showing pre/post-operative management of major foot and ankle surgeries within their centre, n (%)
Factor | Result |
All patients seen pre-operatively by physiotherapy | Yes (n = 80) (61) |
No (n = 45) (34) | |
Unsure (n = 7) (5) | |
All patients seen post-operatively by physiotherapy | Yes (n = 92) (70) |
No (n = 28) (21) | |
Unsure (n = 12) (9) | |
Post-operative contact made to the patient | Yes (n = 20) (15) |
No (n = 92) (70) | |
Unsure (n = 20) (15) | |
Outcome measures recorded for day-casea | VAS (n = 45) (34) |
Complication rate & type (n = 41) (31) | |
Patient satisfaction (n = 13) (10) | |
MOX-FQ (n = 42) (32) | |
EQ-5D (n = 31) (23) | |
Other (n = 7) (5) | |
Types of post-op analgesia offered for day-casea | Amitriptyline (n = 1) (1) |
Gabapentin (n = 5) (4) | |
Paracetamol (n = 114) (86) | |
Ibuprofen (n = 64) (48) | |
Codeine (n = 111) (84) | |
Unsure (n = 9) (7) | |
Other (n = 18) (14) | |
Paracetamol & codeine (n = 105) (80) | |
Ibuprofen, codeine & paracetamol (n = 55) (42) | |
Ibuprofen & paracetamol (n = 6) (5) |
Table 4 Results from the survey showing potential barriers to performing major foot and ankle surgeries as day-case within their centre, n (%)
Factor | Result |
Barriers to performing day-case | No out of hours support (n = 28) (21) |
No Physio pre/post-op (n = 31) (23) | |
No Anaesthetist (n = 12) (9) | |
Lack of managerial support (n = 10) (8) | |
Never been done before (n = 9) (7) | |
Non-response (n = 15) (11) | |
Unsure (n = 23) (17) | |
Other (n = 7) (5) | |
Complications heard/witnessed from day-casea | Wound healing (n = 33) (25) |
Wound Infection (n = 23) (17) | |
Breakthrough pain (n = 84) (64) | |
Patient dissatisfaction (n = 33) (25) | |
Unplanned readmission (n = 60) (45) | |
Further surgery (n = 12) (9) | |
Delayed non-union (n = 12) (9) | |
How are patients first re-evaluated after dischargea | 24 h (Face to face, n = 3, 2%) (Telephone, n = 14, 11%) |
1 wk (Face to face, n = 15, 11%) (Telephone, n = 3, 2%) | |
2 wk (Face to face, n = 119, 90%) (Telephone, n = 1, 1%) | |
6 wk (Face to face, n = 54, 41%) (Telephone, n = 2, 2%) | |
Other (n = 9) (7) |
- Citation: Berry A, Houchen-Wolloff L, Crane N, Townshend D, Clayton R, Mangwani J. Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons. World J Orthop 2023; 14(4): 248-259
- URL: https://www.wjgnet.com/2218-5836/full/v14/i4/248.htm
- DOI: https://dx.doi.org/10.5312/wjo.v14.i4.248