A Scoping Survey of BOFAS Membership: What are the Perceived Barriers and Facilitators of Day- Case Surgery for Major Foot and Ankle Procedures in the UK?

Category: Ankle Introduction/Purpose: Recent advances in minimally invasive surgery and improved post-operative pain management make it possible to perform major foot/ ankle operations as day-case. This could have significant impact on length of stay, saving resources and is in keeping with government policy. However there is no consensus of barriers reducing foot/ankle operations being performed as day-case.The aim of this survey was to scope the practice of UK foot and ankle surgeons in terms of perceived barriers and facilitators to performing day-case surgery for major foot/ankle procedures. Methods: An online survey (19 questions) was sent to UK foot and ankle surgeons via BOFAS (British Orthopaedic Foot & Ankle Society) membership list in August 2021. Major foot/ankle procedures are defined as surgery that is usually performed as an inpatient and day-case as same day discharge, with day surgery as the intended treatment pathway. Results: A total of 132 respondents: 80% working in Acute NHS Trusts. 78% of respondents thought that more procedures could be performed as day-case at their centre (currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures). The top 2 perceived barriers to performing more major foot and ankle procedures as day-case were: no physiotherapy provision pre/ post-operatively 23%, no out of hours support for patients 21%. Conclusion: There is consensus among surgeons to do more major foot/ ankle procedures as day-case. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. Out of hours support and physiotherapy input pre/post-op were perceived as the main barriers to increasing the number day-case procedures. There is a need for nationally agreed protocols to optimise the delivery of care for this patient group and to scope the provision of physiotherapy pre/post-operatively at sites where this is a perceived barrier.