Ten years of acute hand trauma: is day case surgery still working? A review of 726 patients

Background Day surgery units (DSUs) have streamlined the treatment of hand trauma. This study describes how the establishment of the Birmingham Hand DSU has improved the service over a 10-year period. Methods Data was collected on patients requiring surgery for acute hand trauma for a period of 1 month at four separate time points: (1) prior to establishment of DSU, (2) 1 month following DSU opening, (3) 1 year following DSU opening and (4) 8 years following DSU opening. The number and types of operation performed, day case rates, and bed occupancy rates were analysed. Statistical analysis was performed using Fisher’s exact test. Results The volume of hand trauma has increased over time (77 cases/month-2002; 109-2003; 90-2004; av. 150-2011). Sharp lacerations and crush injuries remain the most common. The percentage of patients admitted has fallen (84.4% 2002; 64.2% 2003; 46.7% 2004; 33.6% 2011 p = 0.0003) whilst the day case rate has increased (13.0% 2002; 33.9% 2003; 51.1% 2004; 67.5% 2011 p = 0.004). Bed occupancy rate per patient has fallen (2.64 days-2002; 2.08-2003; 1.34-2004; 1.21-2011). Conclusions Despite an increased caseload, increased utilisation of the DSU has led to reduced patient waiting times and bed occupancy rates whilst increasing patient satisfaction and reducing costs. Level of Evidence: Level III, risk/prognostic study.