Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2023; 14(4): 248-259
Published online Apr 18, 2023. doi: 10.5312/wjo.v14.i4.248
Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons
Amber Berry, Linzy Houchen-Wolloff, Natalie Crane, David Townshend, Robert Clayton, Jitendra Mangwani
Amber Berry, Department of Physiotherapy, Spire Hospital, Leicester LE2 2FF, United Kingdom
Linzy Houchen-Wolloff, Natalie Crane, Department of Physiotherapy, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
David Townshend, Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, North Sheilds NE29 8NH, United Kingdom
Robert Clayton, Department of Orthopaedics, Victoria Hospital, Kirkcaldy KY2 5AH, United Kingdom
Jitendra Mangwani, Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
Author contributions: Mangwani J, Townshend D, Clayton R contributed to concept; Berry A, Houchen-Wolloff L, Crane N, Clayton R contributed to data collection; Houchen-Wolloff L, Mangwani J, Clayton R contributed to data analysis; Mangwani J, Houchen-Wolloff L, Townshend D contributed to data interpretation; Berry A, Houchen-Wolloff L, Crane N contributed to writing the manuscript; Mangwani J, Crane N, Townshend D, Clayton R contributed to manuscript critical revision.
Institutional review board statement: Did not have IRB approval but was approved by the BOFAS scientific committee.
Informed consent statement: Not applicable for this type of submission-survey.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Linzy Houchen-Wolloff, PhD, Senior Research Physiotherapist, Department of Physiotherapy, University Hospitals of Leicester NHS Trust, Glenfield Hospital Groby Road, Leicester LE3 9QP, United Kingdom. linzy.houchen@uhl-tr.nhs.uk
Received: November 28, 2022
Peer-review started: November 28, 2022
First decision: January 20, 2023
Revised: February 4, 2023
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: April 18, 2023
Abstract
BACKGROUND

Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case. This could have significant benefits for patients and the health service. However there are theoretical concerns about post-operative complications and patient satisfaction due to pain.

AIM

To scope the current practice of foot and ankle surgeons on day-case surgery for major foot and ankle procedures in the United Kingdom (UK).

METHODS

An online survey (19 questions) was sent to UK foot and ankle surgeons via the British Orthopaedic Foot & Ankle Society membership list in August 2021. Major foot and ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge, with day surgery as the intended treatment pathway.

RESULTS

132 people responded to the survey invitation with 80% working in Acute NHS Trusts. Currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures. 78% felt that there was scope to perform more procedures as day-case at their centre. Post-operative pain (34%) and patient satisfaction (10%) was not highly measured within their centres. Lack of adequate physiotherapy input pre/post-operatively (23%) and lack of out of hours support (21%) were the top perceived barriers to performing more major foot and ankle procedures as day-case.

CONCLUSION

There is consensus among UK surgeons to do more major foot/ankle procedures as day-case. Out of hours support and physiotherapy input pre/ post-op were perceived as the main barriers. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. There is a need for nationally agreed protocols to optimise the delivery of and measurement of outcomes in this type of surgery. At a local level, the provision of physiotherapy and out of hours support should be explored at sites where this is a perceived barrier.

Keywords: Day-case, Foot, Ankle, Physiotherapy, Survey

Core Tip: We have identified an appetite to increase the number of major foot and ankle procedures within United Kingdom foot and ankle surgeons who completed our survey. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. Out of hours support and physiotherapy input pre/post-op were perceived as the main barriers to doing day-case surgery in foot and ankle surgery.