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
ARTICLE HIGHLIGHTS
Research perspectives

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.

Research conclusions

There is consensus amongst United Kingdom (UK) surgeons to do more major foot and ankle procedures as day-case. 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 were perceived as the main barriers.

Research results

A total of 132 respondents completed the survey and 80% worked in Acute NHS Trusts. Currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures. Post-operative pain (34%) and patient satisfaction (10%) was not highly measured within their centres. The top perceived barriers to performing more major foot and ankle procedures as day-case were: Lack of adequate physiotherapy input and lack of out of hours support.

Research methods

Online survey sent to British orthopaedic foot and ankle society members. Quantitative and qualitative data collected.

Research objectives

To scope the current practices of UK foot and ankle surgeons on day-case surgery for major foot and ankle procedures.

Research motivation

Day-case is used in other orthopaedic procedures with benefits of patients and providers.

Research background

There are currently no specific guidelines for day-case surgery in major foot and ankle procedures.