title: Factors influencing selection for a day-case or 23-h stay procedure in transanal endoscopic microsurgery.
abstract: BACKGROUND
  Transanal endoscopic microsurgery (TEMS) is an alternative to radical resection of the rectum for benign lesions and early rectal cancer. This study aimed to identify whether day-case TEMS is safe and which factors dictate patient suitability and length of stay (LOS).
  
  
  METHODS
  Details of patients undergoing TEMS resection were retrieved from a tertiary referral prospective database.
  
  
  RESULTS
  Of 96 patients, 46 (48 per cent) were day cases, 24 (25 per cent) had a 23-h stay and 26 (27 per cent) were inpatients. The frequency of day-case surgery increased significantly over the study interval (P = 0.050). Distance of the lesion from the anorectal junction, malignant potential and travel distance had no bearing on LOS. Older age (P = 0.004) and duration of surgery (P = 0.002) correlated significantly with increased LOS. Lesions covering one quadrant involved a significantly shorter stay than those covering two or more quadrants (P = 0.002). Maximum diameter (mean 5.7 cm) was strongly related to LOS (P = 0.009). Day-case and 23-h stay patients had a significantly higher proportion of lower-risk lesions (P = 0.001).
  
  
  CONCLUSIONS
  High-volume day-case TEMS appears safe, even when long travel distances are involved. With advances in practice and procedural safety, traditional risk factors may not be as important as currently thought.
authors.affiliation: Department of General Surgery, Cheltenham General Hospital, Cheltenham, UK. samuelford@hotmail.co.uk
authors.forename: S J
authors.initials: SJ
authors.lastname: Ford
authors.forename: J M D
authors.initials: JM
authors.lastname: Wheeler
authors.forename: N R
authors.initials: NR
authors.lastname: Borley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data*; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*