title: Re-evaluating selection criteria for local anaesthesia in day surgery.
abstract: Day surgery is an increasing element of surgical practice, particularly in plastic surgery. A large proportion of work is undertaken using local anaesthesia in the elderly who have associated co-morbidity. At present no national guidelines exist for the use of local anaesthesia in day surgery. This study aimed to examine the relationship between patient selection and complications, in order to identify those who should be excluded from local anaesthetic day surgery treatment. A retrospective analysis of patients undergoing local anaesthetic plastic surgical procedures over a 10-month period identified 328 operative episodes. There were 37 complications, two of which required admission 5 days post surgery for treatment of wound infection. The remaining complications were treated on an outpatient basis. An increased level of complication was seen in males with elevated systolic blood pressure and with the use of full thickness skin grafts in reconstruction. Age, smoking, ASA grade, and medication that altered coagulation (aspirin, warfarin and steroids) were not associated with increased complication levels. We conclude that local anaesthetic plastic surgical procedures are associated with a very low level of risk, and are suitable for those patients traditionally regarded as unsuitable for general anaesthetic day surgery.
authors.affiliation: Department of Plastic Surgery, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK. lizgeorgeuk@yahoo.co.uk
authors.forename: E N
authors.initials: EN
authors.lastname: George
authors.forename: D
authors.initials: D
authors.lastname: Simpson
authors.forename: D J A
authors.initials: DJ
authors.lastname: Thornton
authors.forename: Tim La H
authors.initials: TL
authors.lastname: Brown
authors.forename: R W
authors.initials: RW
authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D000704:Analysis of Variance; D000772:Anesthesia, Local / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012044:Regression Analysis; D012189:Retrospective Studies