aThe success of day case treatment of zygomatic and orbital fractures

Abstract Traditionally, surgical management of zygomatic maxillary-complex (ZMC) and orbital fractures occurs within two to three weeks of the injury followed by an overnight admission to allow for extended eye observations. This is due to the risk of post-operative retrobulbar haemorrhage (RBH) or orbital compartment syndrome (OCS), a rapidly progressive and sight threatening emergency which requires immediate intervention. In September 2016 the Oral and Maxillofacial Surgery (OMFS) department at Leeds Teaching Hospitals redesigned their trauma service with a full-time trauma consultant, dedicated clinic and a weekly morning elective trauma theatre list. This allowed for standardisation in the management of patients with OMFS injuries. Furthermore, a formal day case ZMC and orbital fracture pathway was developed allowing for patients to undergo surgical management of such fractures with a same day discharge. This has since been identified as an area of excellence by the Getting It Right First Time (GIRFT) programme and is in line with the addition of ZMC and orbital fractures to the procedural list written by the British Association of Day Case Surgery (BADS). Unbeknown to the unit, the volume of day case procedures was the highest within the UK, demonstrating the importance of GIRFT in highlighting areas of good or unique practice. The aim of this study was to determine the impact of our day case pathway and designated OMFS trauma service on compliance with recent recommendations by GIRFT and BADS. Secondly, to determine the safety of same day discharge with regards to post-operative complications.