Page last updated at 09:05 GMT, Monday, 7 December 2009

Kidney removal as day case surgery

Anna-Marie Lever
Health reporter, BBC News


Watch Wayne Littlejohn have his kidney removed and return home the same day.

"It's a challenge and a brave decision, but our patients are driving it," says Anurag Golash, a consultant urologist at the University of North Staffordshire Hospital.

The centre is the only place in the world to perform kidney removal using keyholes as day case surgery.

The patient is allowed to go home the same day as the operation, rather than stay in hospital overnight, if they so wish.

Usually it is typical for a patient to stay in hospital for one to three nights after such an operation.

Comfort of your own home

"I was given the choice - I chose going home," said Mr Littlejohn, just arrived home after having a kidney removed.

"I get bored in hospital, nothing is better than being in your own bed.

"I have my sport on TV and my family around to help me."

Patients also benefit from a quieter place to recover, are less likely to have their operation cancelled due to lack of beds or pick up a hospital-acquired infection.

When Mr Golash started offering this option to his patients in 2006 it did raise a few eyebrows within the medical community.

Anurag Golash
Mr Golash: "It was a brave decision and a very stressful one."

"He was questioning conventional wisdom and did receive some criticism," said Dr Ian Smith, anaesthetist and President-elect of the British Association of Day Surgery (BADS).

Since then the hospital has performed 30 kidney removal operations as day case surgery. Only one woman decided to return to hospital after feeling insecure at home.

As well as kidney removal, the University of North Staffordshire Hospital is the only place in the UK to perform removal of the adrenal glands (eight so far) and pyeloplasty (relieving obstruction of the kidney - 30 to date) as day case.

Apart from keyhole renal surgery, this hospital also performs laser prostate surgery as day case.

A safety net

Day surgery for simpler operations such as gall bladder removal, hernias, and tonsillectomy is now routine, but it is the risk to patient safety of performing more major surgery as day case, that has some people concerned.

Mr Golash said: "The main worry is bleeding, but in my opinion, if this happens, it is during the time of the operation and sorted then and there.

"It doesn't tend to happen 24-48 hours after the operation, in my experience."

The patient is then monitored and evaluated in hospital for six to eight hours before a decision is made to send them home.

A district nurse checks on the patient in the evening and subsequent days afterwards and the patient administers their own pain relief.

Wayne Littlejohn
Wayne Littlejohn was in and out of hospital in a day

"We don't want patients to feel like we have kicked them out," said Mr Golash.

"We give then emergency telephone numbers to ring back directly to the urology ward if there is any problem. There is a big safety net in place."

In the early days, such was Mr Golash's support and dedication to a new way of thinking, he would even phone his patients himself in the evening to check their progress.

Thinking about pain

Not every patient having a kidney removed may be suitable for day case surgery - there are rigorous selection factors.

These look at how well the patient can be supported at home, the patient's general health and the complexity of the operation. Approximately 15-20% of patient's in Mr Golash's practice are suitable for day case kidney removal.

One of the main differences between day case and inpatient procedures is pain relief.

"We need to plan the pain relief more carefully with a day case patient," says Dr Smith.

"With an inpatient we tend not to think ahead so much as we can be more reactionary."

Rather than using the traditional pain relief drug morphine, which can make patients sick, Dr Smith uses slow releasing ibuprofen and supplements this with paracetamol and codeine after the operation.

Currently around 60% of all surgery in the UK is day case surgery, but Dr Smith would like to see more major surgery exploring this option.

"Historically we have asked: 'Is this patient suitable for day surgery?'.

"What we need to start asking is: 'Is there any reason to admit this case as an inpatient?'

"We need a cultural shift in thinking, both from patients and medical staff, about the need to stay in hospital."

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