Factors influencing selection for a day-case or 23-h stay procedure in transanal endoscopic microsurgery.
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.
Ford
S J
SJ
Department of General Surgery, Cheltenham General Hospital, Cheltenham, UK. samuelford@hotmail.co.uk
Wheeler
J M D
JM
Borley
N R
NR
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*