Implementation of a 23‐h surgery model in a tertiary care hospital: a safe and feasible model with high patient satisfaction

BACKGROUND: The 23-h surgery model consists of elective operative care with an overnight hospital stay for patients unsuitable for day case surgery. The aim of this study was to assess the success of the 23-h surgery model. METHODS: This was a prospective follow-up study of patients undergoing surgery with the planned 23-h model in a tertiary-care university hospital during a 12-month period 2 years after the model was implemented. Patients were interviewed 2 weeks after surgery, and the hospital operative database and patient records were searched. The primary outcome was the success of the process, defined as discharge before 10.00 hours on the first morning after surgery. Secondary outcomes were 30-day readmission and reoperation rates, adverse events, and patient satisfaction with the process. RESULTS: Between May 2017 and May 2018, 993 adult patients underwent surgery with the 23-h model, of whom 937 adhered to the model as planned (success rate 94.4 per cent). Gynaecological, gastrointestinal and orthopaedic surgery were the three most common surgical specialties. The surgical process was changed to an in-hospital model for 45 patients (4.5 per cent), and 11 (1.1 per cent) were discharged on the day of surgery. The readmission rate was 1.9 per cent (19 of 993), and five patients (0.5 per cent) had a reoperation within 30 days of surgery. Fifty-nine adverse events were noted in 53 patients (5.3 per cent), most commonly infection. Patient satisfaction was a median of 6-7 (maximum 7) points for various aspects of the model. CONCLUSION: The success rate and patient satisfaction for the 23-h surgery model was high.