SAFE SURGERY IN DAY CARE CENTERS: FOCUS ON PREVENTING MEDICAL LEGAL ISSUES

D. Șerban, C. M. Brănescu, G. C. Smarandache, C. Tudor, C. Tănăsescu, M. S. Tudosie, D. Stana, D. O. Costea, A. M. Dascălu, R. I. Spătaru,

Abstract: Under the pressure of economic efficiency of medical care, day care surgery is a growing concept which should be considered more frequent in the clinical practice, in all surgical specialties. On the other hand, early discharge after surgery comes with its own challenges, which can result in medico-legal issues if the outcome is not totally favorable for the patient. The paper aims to review the previous published articles on the specific challenges related to safe surgery in the day- care environment. A search was performed on PubMed/Medline, Springer Nature and Google Scholar for all papers published between 2000 and 2020, by the terms: “day care surgery” and “safe surgery” and/or “medico-legal issues”. The concept of “day surgery” or “outpatient surgery” has developed unevenly depending on the area and surgical specialties. Informing patients is particularly important, as they will become an active partner in the patient-physician relationship in preoperative training and postoperative care. A special attention must be paid to the proper selection of patients who can benefit from day-care surgery, in this sense a very important role is played by the decision of the anesthetist. When deciding whether a patient is acceptable for day surgery, multiple factors should be taken into account, to minimize the risk of medico-legal issues. While obviously not all the procedures could be performed on daily basis, there is clinical evidence that day surgery is safe and effective in elective cases, with an anticipated simple outcome, and in well selected patients. A complete preoperatory evaluation, as well as detailed information previous obtaining informed consent are extremely important to increase the safety and minimize the risk of adverse events in outpatient surgery.
Keywords: safety, day care surgery, risks, medico-legal issues, patients’ selection