Establishing a safe pediatric surgery day unit: Process, procedures, and performance

Abstract

Abstract Background: Ambulatory surgery for babies and infants is commonly practiced worldwide. There are no reports on this special service from the UAE. A Pediatric Surgery Day Unit (PSDU) has been in operation at Danat Al Emarat Hospital Women and Children since the hospital opened in 2016. Objective: To describe the day-to-day structure and functioning of the PSDU, the technical aspects of the four main procedures delivered (Circumcision, Release of Tongue Tie, Excision of Umbilical Granuloma, and Excision of Accessory Digits) and the outcomes for the babies. Materials and Methods: The hospital’s Health Information System was interrogated for the relevant diagnostic and procedural codes for all babies operated between January 1st, 2016, and December 31st, 2019. Data were analyzed for basic demographics, biostatistics, procedures performed, and follow-up encounters. Results: The PSDU has a core team, including a coordinator/scheduler, one practical nurse, two staff nurses, and two surgeons. Up to 10 sessions are offered per week, and out-of-hours cover is provided for emergencies or advice on a 24/7 basis. A total of 5262 medical records were examined and data on 3891 procedures for 3801 babies were analyzed. Babies of 68 nationalities were operated and 65% were local Emirati. Circumcision was performed at a median age of 16 days and a weight of 3.5 kg. Bleeding occurred in 1.4% and retention of the ring occurred in 1%. Significant factors associated with bleeding are age, weight, and ring size. There is no difference in bleeding rates between surgeons. There is a learning curve for the technique. Retention of the ring on the glans is associated with the size of ring chosen and retention rates vary significantly between surgeons. The remaining procedures were performed without complication, giving an overall adverse event rate of 2.75%. Conclusion: A well-structured and consistently staffed PSDU results in a safe and effective service.