To ask anyone in the NHS how day surgery lists are determined?

The pre-op people are usually nursing staff just going through a list to rule out issues that might cause a problem in surgery etc; they usually won’t know the details of any surgical procedure themselves, but ideally you should have had at least one consultation with ENT before being listed for sinus surgery where they could have gone through the details.

But I’m very aware that often these days it’s something that can get brought up at the end of a consultation eg we could book you in for surgery on your sinuses which might help if you’d like us to do that? And if you say yes you might assume that at some point someone will explain a bit more about the details of it to you and I do think prepandemic if you were waiting 2 years for it that would have happened, but I agree that doesn’t always happen these days ahead of time. I was listed for gallbladder surgery after being admitted for a gallstone complication, so never actually got to speak to a surgeon at all until the day of the procedure. Fortunately with my medical background I basically knew what to expect!

You will get a basic explanation of the procedure tomorrow from the surgeon who will come and see you beforehand to consent you for the operation and make sure you’re happy to go ahead. But I appreciate many people would prefer to have that info ahead of time!

Latex ‘spores’ take time to clear from the air even with high air turnover in theatre. Some people with severe allergies could react to those particles in the air.

Oh and if no MRSA swabs/MRSA positive last on list.

This isn’t true - we have patients going in last on list at 3/3.30/4. Last Thursday I had to find a bed for a patient going in for planned surgery and didn’t get one till 3pm.
surgery at my trust goes
children first, day cases next, inpatients last (to give us more chance to find beds) unless there is clinical reason to change this (diabetics, urgency of surgery, medications that have been stopped)

If it’s a severe latex allergy but there’s another patient who needs to go first you can either treat the other patient as latex allergic too or pause the list between cases to allow any latex to be cleared from the air. Latex-free sterile gloves feel very different to do procedures in so a lot of surgeons don’t like using them unless it’s really needed (as surgery depends very much on feel), but if there’s no alternative they just have to. Most kit apart from gloves is now latex free.

Why does latex allergy mean they need to be first? Surely the theatre should be cleaned thoroughly between each op not just at the end of each day?

They will tell you when you get there. It was a response to someone else saying they’d been allowed to drink. It’s now quite common to allow sips of water, but they won’t know how quickly you’ll be seen until you get there.

Interesting, I have latex allergy and wasn’t first on the list when I had my gallbladder out, but they were aware and did check with me, plus my latex allergy is not severe, just a skin reaction rather than breathing issues etc. But I’m not sure if they just took me to a different theatre where all latex allergic people go or decided as my allergy isn’t severe that it was less of an issue etc.

at some point they should have explained what they are doing? That sounds very strange. In the morning the surgeon will go through a full consent form and explain what will be happening. I guess if it’s surgery you’ve been waiting for for two years you’ve had time to do some research or reach out and explain you’ve been listed for surgery which you don’t know anything about?

No one can answer this as all hospitals have different set ups. Some day surgery units have their own separate theatres. Some hospitals (including the district general hospital that I work in) admit all elective patients via a day surgery unit then day cases and inpatients will be operated on on the same list- order to be decided by the surgeon. Often they do the daycases first as they will have spaces allocated to them on the day case unit rather than having patients sat in recovery all day waiting for a bed on a ward which doesn't become free until much later in the day when someone is discharged. It really just depends unfortunately.

Sip til send is being adopted widely across the nhs allowing patients to sip clear liquids until they are sent for. Makes the wait more bearable and I’m sure helps postoperatively.

OP you sound really really stressed about this. The trouble is that all hospitals work slightly differently, and there are so many variables that I think you’re looking for answers no one here can give you. I can only suggest again that you talk to them (in advance, if possible) and explain the stress and anxiety this is causing you, because there might be things that can be done to help. If you have time before the day of the operation you could start with the consultant’s secretary and go from there.

I do understand, especially because you really are giving up control over your body in a way you wouldn’t normally when you have surgery, especially if it’s under general anaesthetic. A lot of people do find that loss of control quite intimidating, especially if they are usually healthy and haven’t had much experience of this sort of thing before.

And yes they don’t tend to explain much in pre-op! Especially these days (prepandemic you’d often have been able to have a good chat with the surgeon about exactly what is proposed and why and all the ins and outs of it, but that seems to have generally gone out the window). Even I was surprised at how limited the information was beforehand, and I’d probably have found it a lot more daunting if I didn’t have insight as to how it all works from being a junior doctor.

And yes it’s going to be a total change in your usual routine whatever happens but I can see not knowing roughly when it might even happen is particularly challenging for someone with possible autism.

So please do tell them that you suspect you have autism but are usually healthy generally, and so you are finding the lack of control and change of routine and not knowing what to expect particularly anxiety-making and it would really help to know where you are on the list and if possible for your procedure to be done sooner rather than later. And then they can at the very least keep you posted as to what’s happening and whether anything looks like it might change through the morning if needed. I promise they won’t laugh at you or think you’re trying it on etc. Your level of anxiety over this is unusual and makes a lot more sense looking at it from the angle of possible autism.

You never know, you could end up first on the list so try not to panic now and overthink about worst case scenarios.

@ScuderiaSedici

I wonder if these people may be of help?

Oh and don’t expect to see your surgeon after the operation, you’ll wake up in recovery, be taken back to the ward, looked after by the dsu nursing staff and discharged by them. People are often surprised by that.

Someone has to do the waiting unfortunately. If you want to guarantee that you will go to theatre in the morning and not be kept waiting then you should go private where a surgeon will have fewer patients in their list!!

When I had surgery last December they had everyone in at 7am and I was last on the list; I didn’t go to theatre until after 3pm. By the time they got me out of theatre into recovery it was almost 9pm and then it was getting on for 10:30pm by the time I got up to the ward.

They did 5 surgeries before mine and it would have been unfair for the other 5 people to have to wait over 5 1/2 hours to start going down and mine was the most complicated case so I went in last. They did let me drink water until 1pm so I was well hydrated unlike previous times when I’d had nothing since the night before and was as dry as a bone by the time they tried to cannula the me in the anaesthetic room.

16 year olds are still paeds and have been under paeds for years but they’re adult sized

Even if you go private they still do the morning/afternoon sessions, you dont get a specific timeslot (or at least in the hospitals near me that I use). Because some people will test positive for MRSA/pregnancy etc, or operations be quicker than expected and the surgeon is able to move along to the next one quickly.