Day of surgery admission in urology: Patient criteria and the organization required for same-day admission in urology: A retrospective study.

Abstract

Background: The day of surgery admission (DOSA) has been practiced in surgery for decades, with reports dating as far back as 1909. DOSA policy has potential benefits for the health system and the patient, especially when there is a shortage of health-care resources.

Objective: This study aims to compare DOSA and standard prior admission (D-1) among patients who underwent major urological operations.

Methods: This retrospective study enrolled a total of 206 patients who did not meet the criteria for day care surgery admission. The patients were divided into two groups: those admitted on the same day of surgery and those admitted the day before surgery. Among the participants, 111 (53.8%) were admitted on the same day, while 95 (46.2%) were admitted the day before surgery. We collected data from the electronic health records of these patients, documenting various variables, including patient demographics, type of surgery, admission type and date, intervention date, length of stay, complications, Clavien-Dindo score, and American Society of Anesthesiologists (ASA) score.

Results: We included a total of 206 patients who were admitted for operations in the urology department. The mean age was 70.5 years, and the majority was males (83.5%). Endoscopic procedures were the most common interventions (68%). The most ASA score for the enrolled patients was 2 (56.2%). DOSA was done for 53.8% of the patients, whereas the remaining patients were admitted 1 day before elective surgery. DOSA patients were significantly younger (P = 0.025), had a higher proportion of ASA score 1 (12.7%) and ASA score 3 (26.4%), had significantly fewer postoperative complications (P = 0.002), and had statistically significantly a shorter length of stay (P < 0.001) compared to D-1 admission patients.

Conclusion: In our study, DOSA patients were younger, had a lower prevalence of comorbidities, utilized anticoagulants less frequently, experienced fewer complications, and had significantly shorter hospital stays. Since the DOSA policy is safe and has a lower financial and economic burden on the health-care system, we recommend more urological and surgical centers to implement it.