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MM Begani and T Naresh Row

A surgical procedure performed on a non-hospitalised patient, is an accepted and well-established practice of modern day medicine.

Day Case, Day Care, Day Surgery, Major / Minor Ambulatory Surgery, 23-hours surgery, OPD procedures, these are several names, and thus, several definition proposed, debated and revised over several years. The proponents and opponents, including a fair amount of sceptics, are usually associated with any change from norm. With increasing understanding of modern medicine, utilising and exploiting it to the maximum benefit, is necessary for delivering excellent patient care.

When we look around us, we see everything changing to a ‘user friendly’ status. Medical service, as we are now considered, also needs to change its status.
Convenience seems to be the key word, so it should be in medicine too.

Day care surgery is a concept, which has brushed almost everyone in some way or the other. It has its share of advantages and disadvantages.
The advantages out weigh the disadvantages, the utilisation of these benefits to the advantage of your patients and yourself, are the essence of this concept.merits of this concept, we decided to compile thoughts and scientific data, in brief, for your perusal.

When we thought of Day Care work, which we have been practicing since several years, we encountered our share of encouragements and criticism. To present to you the Our exposure to Day Care work was due to the encouragement of Late Dr. P. K. Jhawer and Late Dr. G. S. Amberdekar, who were way ahead of time in their view to newer concepts.

Every concept has a history, which is important to know, it tells us the evolution, the reason for change, the mistakes committed, the setbacks, the dedication, the drive, the goal and its realisation, which made our ancestors great people.

Day Care also has a history, started from time immemorial, as old as medicine itself, changing with the times and needs, to reach today’s status.
In India, the great surgeon, Shushrut, has compiled his works, which are comparable to modern medicine. The establishment of hospitals and ambulatory units; and popularised by Ashoka the Great; have been well documented.

Most of the day care work was started, out of necessity. The largest series of 7000 surgeries done and published was in 1909, which were performed as day care, where MacNicoll found that recovery was faster in children who were allowed to recoup at home. Around that time, surgeons and hospital administrators found hospitalisation to be more beneficial to patient’s recovery, in terms of prevention of post-operative infection, thus Day care suffered a set back. With the advent of better antibiotics and asepsis, Day Care surgery was revived during the 40’s and 50’s, but the major bulk of work was done in the 70’s and 80’s, which permanently established Day Care surgery as part of medical care.

With the innovation of better anaesthetic agents, specially Lignocaine and Bupivacaine, Day surgeries received a much needed boost, where it was found unnecessary to keep the patient back in the hospital.

There were several factors, indigenous to that country, which have encouraged innovations in day surgeries. The Americans introduced medical insurance, the cost of medical care could no longer be borne by average person, insurance company thus forced the medical care specialist to cut costs, made him think and thus, adapt the benefits of Day Care surgery.

In U.K., the long wait list, where patients had to wait for several years for surgeries, NHS could not cope-up with the work load, Day care solved the problem.
In India, we find a mixture of both the above problems already staring at us, therefore, over several years, Day Surgery, which has now evolved into an art form, is more and more being utilised by our surgeons.

When we decided to form an association, which would increase the awareness among the medical fraternity and the patient, of this concept, we were met with tremendous response and some criticism, we found more like minded doctors, who are interested in this concept; thus, the formation of The Indian Association of Day Care Surgeons took form, which proposes to include surgeons from all the specialities under one banner, to further the cause of Day Care Surgery.
We commend The Association of Colon and Rectal Surgeons of India, who were the first association to recognise the necessity of teaching the concept of Day Care, and have included this concept as a part of their Instructional Course in Coloproctology, for their Fellowship exams, from this year onwards.
To our knowledge, this is the first compilation in India, of Day Care work, from all specialities, published as a special issue of a leading journal, the Bombay Hospital Journal.

We take this opportunity to thank Bombay Hospital Institute of Medical Sciences, Bombay Hospital Trust, Dr. OP Kapoor, Dr. RJ Mehta and their team, of Bombay Hospital Journal, for inviting us to be the guest editors of this special issue.

While calling for articles, we found great enthusiasm among the contributors. I must thank them, who, inspite of their busy schedule, and shortage of time, wrote so well. Writing on such an ‘abstract’ issue as Day Care, as put by one of the contributors, is not easy, as you will see a great amount of repetition in the articles, which is understandable, as the concept is one, and editing was even more difficult, therefore, without dwelling on the benefits of Day Care Surgery, we present this issue to you.

You will find articles from medical speciality, which, we have included into day care work, as we feel that these specialities are very closely related and require inclusion in this compilation. Specialities like Interventional Cardiology and Interventional Radiology, are included in to the preview of Day Care. What are the guidelines? What should be the protocol governing Day Care work? These and many more issues have to be resolved. They are beyond the scope of this issue, but will surely be discussed in the future.

The sponsors to this issue deserve special thanks for their generous contribution.

As always, the last line is to call for suggestions, changes and improvements, which are necessary for progress, every step is important, clear and careful thinking is mandatory, please let us know your comments and views, which would be valuable to us in our advancement.
One thing needs to be borne in mind and it is that day care does not mean less care. In fact, day care calls for all the more care, precision, planning and ability to take quick decisions. - Dr. LH Hiranandani

MM Begani and T Naresh Row

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