Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons

Table 1 Survey sent to British Orthopaedic Foot and Ankle Society membership list in August 2021

Question 1

What is your occupation?

Open-response

Question 2

In what setting do you work? Select all that apply

Acute NHS Trust -specialist foot and ankle unit

Acute NHS Trust – non specialist foot and ankle unit

District General Hospital

Community care

Private practice

Question 3

Please estimate the number of major foot and ankle procedures that your primary centre performs in 1 calendar year

Less than 20

20-50

50-75

75-100

100-200

200-500

500-1000

Over 1000

Don't know

Question 4

Please estimate what percentage of these major ankle and hindfoot procedures are performed as day case procedures

Open response

Question 5

Do you think there is potential for more of these cases to be done as day case in your own unit?

Yes

No

Question 6

Do you follow a protocol for day case procedures?

Yes- national

Yes- local

No

Unsure

Question 7

If you follow a national protocol for day case surgery, please state which one

Open-response

Question 8

Which type of anaesthesia do you offer for day case procedures? Tick all that apply

Don't know

Regional

General

Combination of GA and regional

Specific blocks

Question 9

If you use blocks, please state which

Open-response

Question 10

Do you routinely discharge day case patients with opiate/controlled drugs such as oxycodone/oromorph?

Yes

No

Unsure

Question 11

What post-op analgesia do you offer for day case procedures? Tick all that apply

Don't know

Amitriptyline

Gabapentin

Ibuprofen

Paracetamol

Codeine

Other: Please state

Question 12

Are all patients seen by physiotherapy pre-op for walking aid/ weight bearing instruction and education?

Yes

No

Unsure

Question 13

Are all patients seen by physiotherapist post-op (before discharge) for walking aid instruction and education?

Yes

No

Unsure

Question 14

Is a post-op phone call/email/text message made to the patient?

Yes

No

Unsure

Question 15

If yes who provides this contact?

Open-Response

Question 16

Which outcome measures are recorded for day-case patients? Tick all that apply

pain levels using Visual Analogue Score (VAS)

patient satisfaction, please state which measure

complication rate and type

MOX-FQ

EQ-5D

Other (please specify)

Question 17

What are the barriers for day case surgery for major foot and ankle procedures in your unit?

No provision of physiotherapist out of hours

No anaesthetist to perform peripheral nerve blocks

Lack of managerial support

Out of hours support/ point of contact for patients not available

Never done it before

No physiotherapy input at pre-assessment

Other: Please state

Question 18

Which complications have you witnessed or heard about in major foot and ankle procedures done as a day case? Tick all that apply

Wound healing problems

Wound infection

Breakthrough pain

Patient dissatisfaction

Unplanned readmission

Need for further surgery

Delayed/non-union

Other, please state

Question 19

When and how are patients first re-evaluated after discharge? Tick all that apply for

24 h face to face

24 h telephone call

1 wk face to face

1 wk telephone call

2 wk face to face

2 wk telephone call

6 wk face to face

6 wk telephone call

Other: Please state

GA: General Anaesthetic.

Table 2 Survey results showing current practices of major foot and ankle surgeries within their centre, n (%)

Factor	Result
Estimated number of major foot and ankle surgeries performed in 1 calendar year	Less than 100 (n = 60) (45)
	100-200 (n = 25) (19)
	200-500 (n = 29) (22)
	500-1000 (n = 9) (7)
	Over 1000 (n = 2) (2)
	Unsure (n = 7) (5)
Estimated procedures performed as day-case	0-50 (n = 99) (75)
	50-100 (n = 30) (23)
	Unsure (n = 3) (2)
Is there a potential for more to be done as day-case	Yes (n = 103) (78)
	No (n = 29) (22)
Follow a protocol for day-case	Yes Local (n = 57) (43)
	Yes national (n = 6) (5)
	No (n = 50) (38)
	Unsure (n = 19) (14)
Types of Anaesthesia offered for day-casea	Regional (n = 63) (48)
	General (n = 69) (52)
	Combination of regional & general (n = 107) (81)
	Specific blocks (n = 100) (76)
	Unsure (n = 3)
Routinely discharge with controlled drugs	Yes (n = 34) (26)
	No (n = 85) (64)
	Unsure (n = 13) (10)

^aPercentage is more than 100 as respondents can select more than 1 option.

Table 3 Survey results showing pre/post-operative management of major foot and ankle surgeries within their centre, n (%)

Factor	Result
All patients seen pre-operatively by physiotherapy	Yes (n = 80) (61)
	No (n = 45) (34)
	Unsure (n = 7) (5)
All patients seen post-operatively by physiotherapy	Yes (n = 92) (70)
	No (n = 28) (21)
	Unsure (n = 12) (9)
Post-operative contact made to the patient	Yes (n = 20) (15)
	No (n = 92) (70)
	Unsure (n = 20) (15)
Outcome measures recorded for day-casea	VAS (n = 45) (34)
	Complication rate & type (n = 41) (31)
	Patient satisfaction (n = 13) (10)
	MOX-FQ (n = 42) (32)
	EQ-5D (n = 31) (23)
	Other (n = 7) (5)
Types of post-op analgesia offered for day-casea	Amitriptyline (n = 1) (1)
	Gabapentin (n = 5) (4)
	Paracetamol (n = 114) (86)
	Ibuprofen (n = 64) (48)
	Codeine (n = 111) (84)
	Unsure (n = 9) (7)
	Other (n = 18) (14)
	Paracetamol & codeine (n = 105) (80)
	Ibuprofen, codeine & paracetamol (n = 55) (42)
	Ibuprofen & paracetamol (n = 6) (5)

^aPercentage is more than 100 as respondents can select more than 1 option.

Table 4 Results from the survey showing potential barriers to performing major foot and ankle surgeries as day-case within their centre, n (%)

Factor	Result
Barriers to performing day-case	No out of hours support (n = 28) (21)
	No Physio pre/post-op (n = 31) (23)
	No Anaesthetist (n = 12) (9)
	Lack of managerial support (n = 10) (8)
	Never been done before (n = 9) (7)
	Non-response (n = 15) (11)
	Unsure (n = 23) (17)
	Other (n = 7) (5)
Complications heard/witnessed from day-casea	Wound healing (n = 33) (25)
	Wound Infection (n = 23) (17)
	Breakthrough pain (n = 84) (64)
	Patient dissatisfaction (n = 33) (25)
	Unplanned readmission (n = 60) (45)
	Further surgery (n = 12) (9)
	Delayed non-union (n = 12) (9)
How are patients first re-evaluated after dischargea	24 h (Face to face, n = 3, 2%) (Telephone, n = 14, 11%)
	1 wk (Face to face, n = 15, 11%) (Telephone, n = 3, 2%)
	2 wk (Face to face, n = 119, 90%) (Telephone, n = 1, 1%)
	6 wk (Face to face, n = 54, 41%) (Telephone, n = 2, 2%)
	Other (n = 9) (7)

^aPercentage is more than 100 as respondents can select more than 1 option.