Apollo Hospitals
Apollo Lifeline National : 1860-500-1066 | Mumbai : 022 3350 3350 022 6280 6280
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GUIDELINES FOR DAY CARE ADMISSION AND DISCHARGE

ADMISSION AND DISCHARGE CRITERIA

Admission Characteristics

  • The Patient should be generally Fit and Ambulant
  • Surgeries not associated with excessive blood loss or fluid shifts
  • Very low risk of serious post- operative complication [E.G. Bleeding or air way obstruction]
  • Surgery Duration upto 1 hour – 2 hours maximum
  • Procedure that are unlikely to require injectable analgesia
  • The patient should be reasonably ambulant afterwards
  • A responsible adult should be available to escort the patient home.

ADMISSION CRITERIA (Specialty wise)

EAR, NOSE AND THROAT SURGERIES

  • Adenoidectomy
  • Antral washout
  • Direct Laryngoscopy and Micro Laryngoscopy
  • Examination of Ear under Anaesthesia
  • Myringoplasty
  • Myringotomy and grommets
  • Tonsillectomy
  • Tympanoplasty
  • Submandibular gland excision
  • FESS
  • Mastoidectomy
  • Neck Node Biopsy
  • Nasal Endoscopy
  • Tongue Biopsy
  • SMR
  • Septoplasty
  • Parotidectomy
  • Thyroidectomy

    • Foreign body removal of ear / nose.
    • Ear lobe repair .
    • I&D of small abscess.
    • Tongue tie release.
    • Small cysts in oral cavity/ face.

GENERAL SURGERIES

  • Anal procedures; GI surgery, lateral sphincterotomy , banding or injection of Hemorrhoids,
  • Hemorrhoidectomy, fistulectomy, Abscess drainage.
  • Breast lumps: excision or biopsy, subcutaneous mastectomy for gyanaecomastia
  • Diagnostic Laparoscopy
  • HERNIA REPAIRS: Inguinal, femoral, umbilical, epigastric, incisional (small)
  • Lymph node biopsy
  • Wound debridement, secondary suturing
  • Laparoscopic cholecystectomy [ cases done between 6am to 2pm]
  • Incision and Drainage of abscess
  • Fistula in Ano
  • Nail Removal
  • Pilonidal sinus
  • Orchidectomy
  • Vasectomy
  • Foreign body removal
    • Excision of lumps - sebaceous cysts, lipomas other miscellaneous swellings,
    • Toe Nail Excision
    • Nail Bed Repair
    • Cyst excision
    • Lipoma excision
    • Laser procedure

Remarks- Any Laparoscopic procedures ,if scheduled in day care list, it’s important to ensure that all the surgeries start latest by 7.30 am and we shall be ready to discharge by 8 pm because they need 12 hrs after general anesthesia, before they are sent back home.

ORTHOPAEDIC SURGERIES

  • Diagnostic Arthroscopy, Meniscectomy, Diagnostic, Biopsy
  • Bunionectomy, hammer to correction
  • Carpal tunnel decompression
  • Dupuytren’s contracture
  • Ganglianectomy
  • Manipulation under Anaesthesia
  • Removal of minor orthopaedic hardware and foreign bodies
  • Local injection
  • Trigger release
  • Dequrvains release
  • Plaster cast Application
  • Surgeries under brachial block that is Humerus, Elbow, Forearm & Hand Fracture in Adults.

PLASTIC SURGERY

  • Ear lobe repair
  • Liposuction
  • Minor hand surgery – Synovectomy, Tendon transfer, Dupuytren’s contracture, Carpal
  • tunnel Decompression
  • Oroplasty
  • Rhynoplasty , Blepharoplasty and other Cosmetic surgery
  • Skin lesions-excision with small flaps and skin graft
  • Minor open Reduction and Internal Fixation
  • Facial wound suturing and other suturing

UROLOGY

OPEN SURGERIES

  • Dorsal Slit
  • Circumcision
  • Meatoplasty
  • DJ stent removal
  • Hydrocelectomy
  • Scrotal surgeries
  • Orchidectomy
  • urethroplasty
  • Testicular biopsy
  • Reversal Vasectomy
  • Secondary suturing
  • Suprapubic cathetrisation
  • Transrectal Prostate Biopsy
  • Diagnostic cystoscopy
  • Cystoscopy with endodilatation
  • Frenuloplasty

ENDOSCOPIC SURGERIES

  • Cystoscopy
  • Cystoscopy + VIU
  • Cystoscopy + Litholapaxy
  • Cystoscopy + BT Dection [small] Fulguration/ Biopsy]
  • Cystoscopy /RGC/RGP/Stenting
  • Cystoscopy + sting + BOTOX
  • Cystoscopy + URS +URS+ ISL+ URS+ Biopsy
  • Diagnostic Laparoscopy + Minor Lap Procedures [E.G] De-roofing of cyst
  • Endoscopic Bronchial Ultrasonography
  • Mini PCNL
  • Endoscopic Bronchial Ultrasonography
  • Mini PCNL

COLORECTAL SURGERIES

  • Anal Fissure
  • Fistula
  • Haemorrhoidectomy
  • Lap Rectopexcy
  • Lap De-functioning of stoma
  • Pilonidal sinus excision
  • Lap Ventral Hernia
  • Lap Appendectomy

VASCULAR SURGERIES

  • A.V. Fistula
  • Perm Cath Insertion / removal
  • Brachial Fistula
  • Toe Amputation
  • Haemangioma Excision / Sclerotherapy
  • R.F.Ablation
  • Wound debridement
  • Sclerotherapy
  • Perm Cath removal

OTHERS

  • Minor procedures not requiring observation for more than 2 hours can be done

EXCLUSION CRITERIA

  • Poorly controlled hypertension [ >170/100]
  • Angina
  • Myocardial infarction, transient ischaemic attack or cerebrovascular accident within last 6 months.
  • Symptomatic valvular disease
  • Cardiomyopathy
  • Severe asthma chronic obstructive pulmonary disease
  • Insulin dependent or poorly controlled non – Insulin dependent Diabetes Mellitus.
  • Renal or Hepatic disease, Alcoholism, Narcotic addiction.
  • Multiple sclerosis [advanced] myasthenia gravis, severe cervical spondylosis.
  • Patient taking Anticoagulant.
  • Patient taking Monoamine oxidase inhibitors
  • Patient taking Digoxin
  • Patient taking Antidysrthmics
  • Patient taking Oral Contraceptives [ Lower Limb surgery ]
  • Patient taking Glyceryl trinitrate.

DISCHARGE CRITERIA

  • Stable Vital signs
    • Systolic BP – 90 to 140 mm Hg
    • Diastolic BP – 70 to 90 mm Hg
    • Pulse Rate – 70 – 100 beats/min
  • The patient must be
    • Oriented to person, time and place
    • Able to tolerate
    • Able to void
    • Able to dress
    • Able to walk without assistance
  • The patient must not have
    • More than minimal nausea or vomiting
    • Excessive pain
    • Bleeding
  • The patient must be discharged both by the person who gave the anesthesia and the person who performed the surgery or their designee.
  • Written instructions for the post-operative period at home including a contact place and person with phone to be reinforced.
  • Patient must have responsible adult to escort them home.
  • Fluid intake is recommended before discharge but not mandatory.
  • Voiding is recommended as a criterion for discharge but not mandatory. It should be required after spinal or epidural block and after pelvic related surgery.
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