Feasibility of day case varicose vein surgery in a district general hospital

Background Day case surgery may reduce inpatient bed requirements, and vari cose surgery may be an ideal operation to test the functioning of a day sur gery service. Aims To evaluate retrospectively the feasibility of day case varicose vein surgery in all-comers, and to identify the risk factors for admission. Methods Over a three-year period from July 1995 to July 1998, all patients requiring varicose vein surgery had their procedure performed as a day case . A standard technique of sapheno-femoral ligation with below-knee strippin g of the long saphenous vein and multiple stab avulsions of varicosities wa s performed. All limbs were dressed with wool in crepe bandage and were rev iewed post-operatively at six weeks. Results Five hundred and forty two patients underwent varicose vein surgery , of whom 26% had bilateral varicose veins, 88% had primary varicose veins and 22% had recurrent disease. The procedure was performed under general an aesthesia in 86% of cases and under spinal anaesthesia in the rest. There w as no peri-operative mortality. Ten patients (1.9%) developed post-operativ e complications. Seventy two per cent of patients were discharged on the da y of surgery, a further 25% required admission for one night due to minor a naesthetic complications and patient preference. Four per cent required adm ission for more than 24 hours. The need for overnight admission was associa ted with the age of the patients (p<0.0001), bilateral varicose vein surger y (p<0.005) and the use of spinal anaesthesia (p<0.01). Conclusion Although varicose vein surgery is safe, acceptable and cost-effe ctive as a day case procedure, if attempted in all-comers, overnight admiss ion will be required in a significant proportion. Pre-operative selection i s advised.