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

[ScuderiaSedici]

As above

Techniques and protocols for hip surgery have evolved.

When my late mother had her hip replaced by the NHS over 25 years ago, she was booked in for a week in hospital.

I had a complex hip replacement operation nearly three years ago, privately.

The surgeon I selected had pioneered day case hip replacement in this part of the country. I had a choice of having my operation done under GA or under spinal block, with or without sedation. I chose spinal block because I have dental implants and a ceramic bridge and I did not want to risk potential damage to the ceramic crowns.

Some of my surgeon's patients elect to have spinal block with no sedation and they are able to talk to the surgical team while the operation is being done.

I chose to have some sedation. I was aware of a feeling of pressure (but no pain) when the initial incision was made and at one point, I was aware of banging (likely when the implant was being hammered down the femoral shaft). Other than that I wasn't aware of anything. I didn't hear the saw when the femoral head was being sawn off and I could not hear voices or music, nor was I aware of the passage of time although it did not feel as though one minute I was asleep and the next I was awake but a hazy, in limbo sort of feeling.

I was booked in for at least one night but in the event I had two nights and was discharged on the morning of the third day. I spent the first night with both legs in an automatic compression device which is noisy and I got no sleep at all, so I was happy to get an extra night in hospital, especially as I was self funding.

I much preferred spinal block to GA although you do have to wait a few hours before the numbness wears off in your legs and you can stand up and get out of bed. Also, I could not empty my bladder for a few hours and that became uncomfortable.

I had posterior approach surgery, but anterior approach is also being used and this can enable patients to have day case surgery and to be more mobile by the next day. As it was, I was walking around on crutches the next morning or using a walker and I was able to do stairs with a walking stick on the morning of the second day after my op and deemed fit for discharge. I could also manage the stairs once I was home.

If I have to have the other hip done in the future I would go for spinal block again and possibly with less sedative, although I'm not sure I'd want to be able to hear everything and talk to the surgical staff.

I hope you recover well, ScuderiaSedici and can find a way to reduce your stress at work.

What do you do?

That's interesting. Thank you.

Absolutely insane, my aunt had her knee done under a spinal block and all she got told was to bring some headphones so that she couldn't hear them sawing her knee!!

I'm going okay - lots of weird things going on and all I got discharged with was an instruction to do nasal rinses, but I wasn't told when to begin. It took the nurse about 15 minutes today to find out!

I'm a trainee solicitor, and under a lot of pressure. My manager is messaging me to find out when I'll be back already, as my original sick note is only for a week - but the hospital told me I can extend it with my GP

Tell your manager where to go. You’ve had surgery and you need time to recover.

Thank you. My friend had a hip replacement a few years ago, and thinking about it now, that may well have been a day surgery. Obviously I was having a senior moment!

So many procedures are day surgeries now. I has a mastectomy in early 2019 and that was a day surgery. I was incredibly anxious, despite it being my decision (as opposed to chemotherapy/lumpectomy/radiotherapy), and my lovely surgeon made sure I was first on his list. I arrived in the elective surgery waiting room at 7.30am and went down to theatre at 9.20am. I was home by 7.30 that evening.

I just messaged back and said that recovery was as bad as I had expected it to be so far - aka, pretty gross and I don't think I'll be back in while I'm using a box of tissues a day!

Yep, good for you. Don’t be bullied into going back before you’re ready. Surgery is a big thing whatever it’s for.

I'm surprised by how head-foggy I feel, despite coming round pretty easily yesterday! I've avoided lying in bed because I think it'll do my head in, but even just sitting at the table watching Netflix has wiped me out. I don't feel like I'll be ready to leave the house next week, for much longer than half an hour or so. I want to be back to being able to walk etc., for a decent period, like I have to do to get to work

That’s not true. I once fasted 3 days in a row until 7pm (the first 2 days I got cancelled) as 7pm was cut off that if you haven’t been put under, then you’ll be cancelled

Anaesthetic stays in your tissues for a while, so you just have to wait it out. You do need to rest though OP - try to get some sleep if you can. It’ll help with the head fog.

Pot luck unless there's a medical reason like diabetics being up first for eg.

it's one of the strangest things I've ever been through! Definitely hitting a heavy cold level of tiredness, as opposed to the complete exhaustion I was expecting. The weather is turning here tomorrow, and that usually completely messes with my sinuses - so that'll be a fun few days for me!

Try and have a nap if you need to, I did for about 3 weeks after my op although mine was a very long one so I guess it knocked me out a bit more
even just half an hour closing your eyes helps

It’s not pot luck, it’s a clinical decision based on circumstance. Diabetes plays a part depending on the fasting period. But there are other concerns such as recovery time and the likelihood of overnight care being needed for late afternoon and evening surgeries.

The amount you pay in tax has absolutely no bearing on the list whatsoever.

I’ve had two lots of day surgery earlier this year. First time I was meant to be on the morning slot and attended at 7.30 am but didn’t get surgery until 3 pm. I was sent home at 6.00 which I thought was a bit quick TBH. The second time it was a slightly easier procedure and I was advised by the surgeon I was likely to be PM as they like to do the operations first where people may need a longer recovery time, so suggested I ring and check as if I wasn’t to be done til the afternoon I didn’t need to get there til midday. But when I rang they advised me I was second on the list for the morning. Easier procedure than the first one and there were obviously no worries about my recovery as I had been operated on similarly only 8 weeks previous, so perhaps they had just slotted me in as an easy one!

The anaesthetic drugs will be long gone by today. People don’t just have anaesthetics in isolation very often….it is for a procedure. An element of the fatigue/woolly feeling will be due to having had your brain interfered with but, although sinus surgery isn’t wildly stimulating, you do get a bit of a physiological stress response to the surgery and some of the other (not strictly anaesthetic) drugs can make you feel a bit funky, combined with the effect of fatigue from the anxiety in the build up, fasting for a bit etc. The anaesthetic drugs I suspect most of us use for an FESS are all pretty short acting and cleared quickly.

Well I typed all that out and now see that you’ve already had the op @ScuderiaSedici
Hope you are feeling OK today. I would also suggest that if you are advised to have any medical treatment in future that you tell the medical staff all your concerns and particularly let them know that you are autistic and need to have things explained to you clearly, it does help.

Well @ScuderiaSedici as someone who sat in the car park in labour with first baby having a panic attack and refusing to go in. You did brilliantly. Hopefully this procedure does the trick for you

It's sometimes if they've done all the necessary swabs etc. Not all patients are totally ready to go.

Yeah. This has been addressed way upthread. We’ve moved on to actual support now OP has had her surgery.

Nope. In and out of hospital all my life due to congenital disabilty. Last surgery was a mastectomy for breast cancer in December as a day case. Was in theatre by 8am and home by 4pm. I was in surgery for in excess of four hours. Had pain in my shoulders and brain fog lasting for two days or so after surgery and was assured that this was down to the way anaesthetic works its way out of your body. You’re not being clever by using abbreviations - what is FESS ?

What ??!!

They can also be done with an epidural and sedation rather than general anaesthetic. For most surgery the biggest risk is anaesthetic - particularly as you get older, but having said that they are the safest they’ve ever been and there are pain free alternatives for those with underlying conditions which increase the risk.

@Rosscameasdoody FESS - Functional endoscopic sinus surgery - it’s the procedure the op had. They’ve used the term themselves either in this thread or one of their others.

And the drugs are eliminated pretty quickly. Historically they hung around longer, but not so much these days. Doesn’t stop people blaming the anaesthetic though, but it’s about lazy to make it so simplistic - there’s a lot more going on than ‘just’ the anaesthetic and It is more of a post-operative phenomenon. The physiological stress response is the release of inflammatory mediators/stress hormones that can leave you feeling rough and the options for reducing that for some procedures is limited.

The ‘anaesthetic’ also consists of a whole bunch of drugs that aren’t actually ‘the anaesthetic’ so there are pain killers (opioids often), steroids (used for their antiemetic properties) etc that can all contribute to feeling pretty funky. Drives me potty that people still just blame the anaesthetic.