Orthopedic Day-case Surgery in Nigeria: A Single-center Experience

Background: The concept of day-case surgeries is relevant in orthopedic specialty in developing countries, where orthopedic elective procedures have relatively longer duration of surgical waiting time, mainly due to lack of inpatient bed space. We aimed to determine the scope, safety and outcome of orthopedic day-case surgeries in a Nigerian setting, and identify potential areas for intervention to improve the practice. Methods: This was a 12-month prospective study of 71 eligible, consenting and consecutive patients who presented at the National Orthopedic Hospital Enugu and were carefully selected and prepared for orthopedic day-case surgeries. Results: Within the period of study, 53 of 540 elective orthopedic procedures were carried out as daycase, giving a day-case surgery rate of 9.8%. Of the patients enrolled, male to female ratio was 1.2:1 and age range was 8 months to 76 years. Eighteen (25.4%) patients had their day-case  procedure cancelled on the day of surgery. The commonest procedure was removal of implant. Conversion rate was 32% mainly due to operation occurring late. Complication (mainly pain) rate was 30%, and correlated with duration of procedure (p<0.006). The satisfaction rate among patients was 98%; no re-admission or mortality was observed. Conclusion: In this study, orthopedic day-case procedures were safe, though there was low use of daycase surgery in scope, complexity and  number of procedures. This and the high conversion rate observed call for a dedicated day-case unit and measures to facilitate timelines of the procedures. Keywords: Orthopedics, Day-case surgery