RESULTS
The extraction process identified 49,223 ESS procedures during the study
period. The procedures were performed across 129 hospital trusts.
Day-case surgery was conducted for 35,494 (72.1%) patients. The
characteristics and outcomes for patients seen as day-case and with
overnight stay are summarised in Table 1 . Patients with an
overnight stay were on average three years older than day-case patients
and more likely to have some level of frailty. Outcomes tended to be
slightly poorer for overnight stay patients, most notably for
complications (including haemorrhage) recorded during the index
admission. Such complications are likely to have necessitated overnight
stay in many cases. Although the one-year mortality rate was higher for
patients with an overnight stay, this partly reflects the older age
structure of the population. Mortality rates were low.
Of the 121 trusts that conducted more than 50 procedures across the
five-year study period, 42 trusts (14,186 patients) performed ≥80% of
procedures as day-case and 15 trusts (4,634 patients) performed
<50% of procedures as day-case. In these 121 trusts, the
highest rate of day-case surgery was 100% in three trusts (561
patients) and the lowest rate was 20.6% (n = 170 patients) in one
trust. The distribution of day-case rates for each trust is summarised
as a funnel plot in Figure 1 .
There was a substantial increase in the proportion of procedures
conducted as day-case across the study period, from 64.0% in financial
year 2014/15 to 78.7 % in financial year 2018/19. Despite this increase
in the overall rate of day-case surgery, in financial year 2018/19,
seven trusts still performed fewer than 50% of ESS procedures as
day-case. The proportion of patients seen as day-case and their outcomes
are shown in Table 2 . Patient outcomes were generally stable
across the five-year period, with no clear trend.
The results of the multilevel, multivariable models comparing outcomes
for day-case and overnight stay patients are presented in Table
3 . The odds of poorer outcomes were generally lower for day-case
patients after adjusting for covariates and in the case of 30-day
emergency readmission, one-year return for ENT surgery and 30-day
complications significant. The results of the analysis comparing trusts
with high and low rates of day-case surgery are presented inTable 4 . There was no significant difference in outcomes
between high and low day-case rate trusts.