10 things you should know about day surgery

1. The pressure on the NHS in the UK has led to a steady increase in the number of elective procedures carried out as day cases since a strategy to move away from inpatient care was introduced in 2002. I have recently had three operations performed on this basis, two in a private hospital (cataract removal) and one in an NHS hospital (breast tumour removal).
2. In the private hospital I had my own en-suit room for the day, with a TV and complementary toiletries (useful Christmas presents). In the NHS hospital I was in a ward with a trolley rather than a bed, on which I was taken to and from theatre. It had flimsy curtains that could be pulled around it. These gave only minimal privacy and no soundproofing. The beds/trolleys were pretty close together. There was just room for a chair, the narrow trolly and a bedside cupboard to leave clothes and a bag – with no locks. In the private hospital there was plenty of free parking, in the NHS one it cost almost £10 for a day, and it proved quite difficult to work out the system and find a machine to take payment. I heard visitors later in the day say that they had spent ages looking for a parking space.
3. In both cases the protocols of admission were the same; a visit from the surgeon, whom one had seen previously, a visit from the anaesthetist, a nurse taking personal details and giving me a wrist band with name and address on. The surgical procedures were explained and consent form signed. In both cases there had been a pre-admission check for MRSA and general health.
4. The staff, including nursing staff and porters, surgeons and anaesthetists in both cases were brilliant. They couldn’t have been kinder, more attentive or more reassuring.
5. The NHS hospital was under far more pressure to keep patients moving through the system, with two shifts of operations a day, morning and afternoon. In the private hospital there was not the same sense of urgency and the room was mine for the day, for as long as I needed it.
6. The private hospital gave me the aftercare notes to read after eye surgery, which was a bit late as I couldn’t read for a few days, and was dependent on my husband to read them to me. They would have been far more useful in advance of the operations (each eye was done a month apart). I only went privately when it became clear that the NHS could not provide the surgery – I had waited 18 months and would not have been able to drive had I waited any longer. In that time I had not even seen the ophthalmologist for an initial assessment. From first ringing the private health care company to completing surgery on both eyes took about nine weeks. If it hadn’t been covered by insurance it would have cost me about £7000.
7. In the NHS hospital I was woken up in the recovery room when still deeply asleep, and wheeled back to the ward. I reacted badly to the general anaesthetic but there was a considerable effort to get me up, dressed, eating and drinking, and discharged so that an afternoon patient could take my place. I felt as if I had a massive hangover (weak, very tired, headache, visual auras, nausea, dizzy) and the nurse in charge eventually accepted that I wasn’t going anywhere quickly. They discharged me early afternoon, as soon as I was able to get dressed and could keep down some liquid and a biscuit, and let me sit uncomfortably to wait for my lift home, as my husband couldn’t come until after work in that evening. In the end I was the first of the day to be operated on and one of the last but one to leave at night.
8. Feeling as sick as I did, the noise of patients’ beepers going off whenever they wanted anything, the constant talking from other patients and more particularly their families, mobile phones going off, and the bright overhead lights was a bit of a torture. Even with my eyes firmly closed all day the lights left my eyes sore and inflamed, as after the cataract operations they are particularly light sensitive. I didn’t have any dark glasses with me and felt too self-conscious to put the discarded hospital gown over my head.
9. I would have been happy to wait in a discharge area to be collected but there was no such space in the NHS hospital. I did feel that there was a certain frustration that I was taking up someone else’s space, even though I had told them that I would not be collected until evening (the operation had been cancelled the week before and rescheduled, making planning logistics particularly difficult). In both cases the protocol was that patients to be collected in person from their room or ward before leaving.
10. I received a follow up call the next day from the surgeon in the case of eye surgery, and breast care nurse in the case of breast surgery. A follow up appointment is scheduled in both instances. Both hospitals looked clean and I had confidence in the care I received.