Presenters from countries included:
· Switzerland · United Kingdom · United States · Australia · Belgium · Poland · Spain · Italy · France · Israel · Germany · Argentina · Japan · Russia · Yugoslavia · Greece · Denmark · Finland · Netherlands · Sweden · Portugal

45 Australians (including partners) attended the conference and 7 sessions presented by Australians.

Quick overview

• New Trends
  - D & Cs replaced with Hysteroscopies in out patients in UK
  - Arthroscopies replaced with MRIs in radiology in UK
  - Trial of replacing TURP with Bipolar vaporisation approach as a daycase in UK

• Office Based surgery
  - 97% of day surgery in Germany is office based
  - is banned in UK
  - major player in US (but with only 5 of 52 states implementing guidelines)
  - has been approved in Australia with strict guidelines

• Pre-admission criteria
  - 10,000 people per day turn 50 years of age in the US Ø Many lively discussions between medical staff as to appropriateness of ASA I, II, III or IV for day surgery
  - Day Surgery cancelled in UK if BMI over 33
  - Finland accepts patients with direct referral from GPs for many different types of day surgery
  - Switzerland expects all patients to have attended pre-admission clinic and all paperwork signed (including informed consent) and delivered 48 hours pre-op or surgery is postponed
  - St Vincent's (Victoria) have criteria to triage outpatients so that only 50% of patients need to attend pre-admission clinics
  - Open day on Sundays held for paediatric cases in a unit in Washington UK with puppet shows etc.

• Anaesthetics
  - Propofol infusion: 50ml syringe not discarded between cases in many countries to decrease cost however, Ian Smith from UK reminded us that cost of Anaesthetic drug for one case is equivalent to one wasted suture!
  - Anaesthetists cannot charge a fee in Belgium for Day Surgery
  - Sweden, Denmark and Finland have Nurse Anaesthetist who intubate etc with limited or no supervision.

• PONV and Pain Control
  - Discussions re use of Simplified Apfel Score to determine risk of PONV
  - Lively discussions between use of Sevo or Propofol. Cambridge results have been only 4% PONV
  - Use of Canabis does not have sufficient evidence based research

• Discharge Criteria
  - Follow up phone calls are perfomed by surgeons and/or anaesthetists in many countries
  - Patients discharged only after review by medical staff in many countries
  - Cataract Surgery: no anaesthetist used in many countries (quoted that 33% of costs were anaesthetists!)
  - Patients charged extra $125 if they go through 1st stage recovery in some centres in US.
  - Patients &/relatives sign that they are happy to be discharged in UK (I questioned the validity considering they have had an anaesthetic!)
  - Day surgery patients in Norway need to be within 30 minutes drive and need to tolerate food and fluids and consultation by surgeon before discharge which must occur before 1800. Further follow up phone call by surgeon following day.

 Compiled by Wendy Adams, NUM DPC at Mt Waverley Private Hospital, May 1st, 2001