Day case orthopaedic trauma surgery effectiveness: a systematic review


  • Donald Buchanan University H of Derby and Burton, UK
  • Islam Sarhan Alexandria University, Egypt
  • Jamie Hind Department of Trauma and Orthopaedics, Oxford University, UK
  • Gur Sidhu Lewisham Hospital, Lewisham High Street London, UK
  • Andrew Dekker University H of Derby and Burton, UK
  • Neil Ashwood University H of Derby and Burton, UK



Day case, Surgery, Trauma, Orthopaedics


Day case surgery facilitates effective orthopaedic care for ambulatory trauma cases and can act as an effective pathway in times of reduced resource availability within acute hospitals. A systematic review of the available literature was performed using a narrative synthesis to look for themes underpinning day case trauma practice. A 25 papers were selected from a total of 9956 papers screened to identify those papers that considered day case trauma surgery and its impact on clinical outcome, patient satisfaction and feasibility of delivery within the UK. 9014 patients had day case trauma operations within the 25 papers identified, 86% had general anaesthesia and 14% either regional or local anaesthesia. The mean reported age was 37.5 years with a wide age range (2-83) years treating roughly similar proportions of men and women with a high satisfaction rate when recorded. All areas of the upper limb were operated on apart from the scapula the commonest being the wrist. In the lower limb surgery was undertaken in the knee, ankle or foot with removal of foreign body or ankle fixation being the commonest procedures undertaken. Prevalence of complications at 0.0156% of cases undergoing day case surgery was seen to be lower than in a similar group of inpatient cases. resources are stretched. Day case surgery for trauma procedures within orthopaedics is safe, cost effective and well tolerated by patients. It frees up resources to facilitate treatment and should be utilised within each hospital to enable timely care.


Anderson T, Walls M, Canelo R. Day case surgery guidelines. Surgery (Oxford). 2017;35(2):85-91.

Athar MS, Fazal MA, Ashwood N, Arealis G, Buchanan D, Okoth FH. Daycase trauma list: a safe and cost-effective service delivery. Ann R Coll Surg Engl. 2019;101:519-22.

Ahmed A, Mohamed N, Mohammed H, Islam S, Neil A. Time Frame to Surgery from Presentation of Ankle Fractures and the Impact of the BOAST Standards, do we meet theBOAST Guidelines? J Orthop Bone Disord 2022. J Ortho Bone Disord. 2022;6(4):000228.

Aveyard H, Payne SA, Preston NJ. A post-graduate's guide to doing a literature review in health and social care. Oxford: Oxford University Press. 2016;200.

Aynardi M, Post Z, Ong A, Orozco F, Sukin DC. Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study. HSS J 2014;10:252.

Bharma JS, Dhinsa BS, Davies C, Oliver M. Does a dedicated orthopaedic day surgery list improve delivery of trauma services? J Periop Pract. 2017;27(11):263-7.

Bhattacharyya M, Gerber B. Minimally invasive repair of ruptured Achilles tendon as a day case procedure with early full weight bearing. J One-day Surg. 2007;17(3):71-5.

BOAST standards. Avaiable at: Accessed on 25 June, 2023.

Bradley B, Middleton S, Davis N, Williams M, Stocker M, Hockings M et al. Discharge on the day of surgery following unicompartmental knee arthroplasty within the United Kingdom NHS. Bone Joint J. 2017;99-B:788-92.

Bullock TS, Gutierrez-Naranjo JM, DelBello RG, Karia RA, Zelle BA. Outpatient surgery in patients with ankle fractures minimises hospital admissions and utilisation of healthcare resources. Int Orthop. 2021;45(9):2395-400.

Chandratreya AP, Spalding TJ, Correa R. Development and efficiency of an acute knee trauma list. Injury. 2006;37(6):502-6.

Charalambous CP, Zipitis CS, Yarwood S and Hirst P. The development of a protocol in using day surgery for minor orthopaedic trauma patients. Ann R Coll Surg. 2003;85:28-31.

Colgate-Stone T, Roslee C, Shetty S, Compson J, Sinha J and Tavakkolizadeh. Audit of trauma case load suitable for day surgery trauma list and cost analysis. Surgeon. 2011;9:241-4.

Crawford DC, Li CS, Sprague S, Bhandari M. Clinical and Cost Implications of Inpatient Versus Outpatient Orthopedic Surgeries: A Systematic Review of the Published Literature. Orthop Rev (Pavia). 2015;7(4):6177.

Curtis MJ, Samsoon G, Parmar N. Fixation of Clavicle Fractures: The role of day surgery? J One-day Surg. 2004;14(4):89-90.

Dayananda KSS, Mercer ST, Agarwal R, Yasin T, Trickett RW. A comparative review of 1,004 orthopaedic trauma patients before and during the COVID-19 pandemic. Bone J Open. 2020;1(8):568-75.

Goh GS, D'Amore T, Courtney PM, Hozack WJ, Krueger CA. Total Joint Arthroplasty at a Novel "Hyperspecialty" Ambulatory Surgical Center with Extended Care Suites is as Safe as Inpatient Arthroplasty. Arthroplast Today. 2022;16:242-246.

Department of Health. The NHS Plan: a plan for investment. a plan for reform. London: DoH, 2000. Avaiable at: Accessed on 23 Septe, 2023.

Dillon CK, Chester DL, Nightingale P, Titley OG. The evolution of a hand day-surgery unit. Ann R Coll Surg Engl. 2009;91(7):559-64.

Ding BTK, Decruz J, Kunnasegaran R. Time-sensitive ambulatory orthopaedic soft-tissue surgery paradigms during the COVID-19 pandemic. Int Orthop. 2020;44(8):1531-8.

Erickson BJ, Shishani Y, Jones S, Sinclair T, Griffin J, Romeo AA et al. Outpatient vs. inpatient reverse total shoulder arthroplasty: outcomes and complications. J Shoulder Elbow Surg. 2020;29(6):1115-20.

Lloyd J, Lockhart J, Sisak K, Middleton R. Acute care: Optimising day of surgery admissions. Health Serv J. 2012;122(6295):28-30.

Stull J D, Bhat S B, Kane J M and Raikin S M. Economic Burden of Inpatient Admission of Ankle Fractures. Foot Ankle Int. 2017;38(9):997-1004.

Howells N, Tompsett E, Moore A, Hughes A and Livingstone J. Day Surgery for Trauma patients. J One Day Surg. 2009;19(1):23-6.

Qin C, Dekker RG, Blough JT, Kadakia AR. Safety and Outcomes of Inpatient Compared with Outpatient Surgical Procedures for Ankle Fractures. J Bone Joint Surg Am. 2016;98(20):1699-705.

Schonauer F, Garner JP, Pereira JA, Pickford MA. Introduction of a hand trauma day surgery operating list. Ambul Surg. 2001;9(2):99-102.

Goel DP, Chan D, Watson K, Mohtadi N. Safety and hospital costs of Achilles tendon surgery: the serendipitous impact of a randomized clinical trial. Can J Surg. 2009;52(6):467-72.

Mukundan C, El Husseiny M, Rayan F, Salim J, Budgen A. "Mini-open" repair of acute tendo Achilles ruptures--the solution? Foot Ankle Surg. 2010;16(3):122-5.

Macquet AJ, Christensen RJ, Debenham M, Wyatt M, Panting AL. Open repair of the acutely torn Achilles tendon under local anaesthetic. ANZ J Surg. 2011;81(9):619-23.

Mohan A, Thomson RM, Titley G, Chester DL. Ten years of acute hand trauma: is day case surgery still working? A review of 726 patients. Eur J Plast Surg. 2016;39:287-92.

Shen MS, Dodd AC, Lakomkin N, Mousavi I, Bulka C, Jahangir AA, Sethi MK. Open treatment of ankle fracture as inpatient increases risk of complication. J Orthop Traumatol. 2017;18(4):431-8.

Whiting PS, Rice CD, Avilucea FR, Bulka CM, Shen MS, Obremskey WT et al. Patients at Increased Risk of Major Adverse Events Following Operative Treatment of Distal Radius Fractures: Inpatient versus Outpatient. J Wrist Surg. 2017;6(3):220-26.

Rider CM, Hong VY, Westbrooks TJ, Wang J, Sheffer BW, Kelly DM et al. Surgical Treatment of Supracondylar Humeral Fractures in a Freestanding Ambulatory Surgery Center is as Safe as and Faster and More Cost-Effective Than in a Children's Hospital. J Pediatr Orthop. 2018;38(6):e343-8.

Garon MT, Massey P, Chen A, Carroll T, Nelson BG, Hollister AM. Cost and Complications of Percutaneous Fixation of Hand Fractures in a Procedure Room Versus the Operating Room. Hand (N Y). 2018;13(4):428-34.

Trowbridge S, Wignadasan W, Davenport D, Sarker S, Hunter A, Gidwani S. Is it safe to restart elective day-case surgery? Lessons learned from upper limb ambulatory trauma during the COVID-19 pandemic. J Clin Orthop Trauma. 2020;11(5):S700-3.

Wolfstadt JI, Wayment L, Koyle MA, Backstein DJ, Ward SE. The Development of a Standardized Pathway for Outpatient Ambulatory Fracture Surgery: To Admit or Not to Admit. J Bone Joint Surg Am. 2020;102(2):110-18.

Hockensmith LH, Muffly BT, Wattles MR, Snyder EN, McFarland BJ, Jacobs C et al. Evaluating Perioperative Complications Surrounding Supracondylar Humerus Fractures: Expanding Indications for Outpatient Surgery. J Pediatr Orthop. 2021;41(9):e745-9.

Shnaider I, Chung F. Outcomes in day surgery. Curr Opin Anaesthesiol. 2006;19(6):622-9.

Lazic S, Boughton O, Kellett CF, Kader DF, Villet L, Rivière C. Day-case surgery for total hip and knee replacement: How safe and effective is it? EFORT Open Rev. 2018;3(4):130-5.

Siow M, Cuff G, Popovic J, Bosco J. An Evaluation of Patient Risk Factors to Determine Eligibility to Undergo Orthopaedic Surgery in a Freestanding Ambulatory Center A Survey of 4,242 Consecutive Patients. Bull Hosp Jt Dis (2013). 2017;75(3):201-6.

Morris DLJ, Fitzpatrick E, Rajan R. Ankle fractures-An audit of BOAST 12 guidelines. J Orthoplast Surg. 2019;2:(2).

Mahmood I, Chandler H, Kottam L, Eardley W, Rangan A, Baker P. Neuromuscular Electrostimulation Device Reduces Preoperative Edema and Accelerates Readiness for Theater in Patients Requiring Open Reduction Internal Fixation for Acute Ankle Fracture. Techn Foot Ankle Surg. 2020;19(4):215-9.

Shin JJ, Popchak AJ, Musahl V, Irrgang JJ, Lin A. Complications After Arthroscopic Shoulder Surgery: A Review of the American Board of Orthopaedic Surgery Database. J Am Acad Orthop Surg Glob Res Rev. 2018;2(12):e093.

McCracken GC, Montgomery J. Postoperative nausea and vomiting after unrestricted clear fluids before day surgery: A retrospective analysis. Eur J Anaesthesiol. 2018;35(5):337-42.

Nylén S, Carlsson B. Time factor, infection frequency and quantitative microbiology in hand injuries: a prospective study. Scand J Plast Reconstr Surg. 1980;14(2):185-9.

Roberts AH, Teddy PJ. A prospective trial of prophylactic antibiotics in hand lacerations. Br J Surg. 1977;64(6):394-6.

Hargreaves DG, Drew SJ, Eckersley R. Kirschner wire pin tract infection rates: a randomised controlled trial between percutaneous and buried wires. J Hand Surg Am. 2004;29(4):374-6.

Hind J, Sidhu GAS, Kotecha A, Kitsis C, Ashwood N. Getting it Right First Time in Trauma Clinic: How a Pandemic Improved Service Provision for Orthopaedic Patients. Med Clin Res. 2020;5(9):205-9.

Fabricant PD, Seeley MA, Rozell JC, Fieldston E, Flynn JM, Wells LM et al. Cost Savings From Utilization of an Ambulatory Surgery Center for Orthopaedic Day Surgery. J Am Acad Orthop Surg. 2016;24(12):865-71.

Megaloikonomos PD, Thaler M, Igoumenou VG, Bonanzinga T, Ostojic M, Couto AF et al. Impact of the COVID-19 pandemic on orthopaedic and trauma surgery training in Europe. Int Orthop. 2020;44(9):1611-9.

Elgalli M, Hind J, Lahart I, Sidhu GAS, Athar S, Ashwood N. Outcomes of day case shoulder replacement surgery in a stand-alone day care unit in the United Kingdom. Shoulder Elbow. 2022;0(0).

Majholm B, Engbæk J, Bartholdy J, Oerding H, Ahlburg P, Ulrik AM et al. Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures. Acta Anaesthesiol Scand. 2012;56(3):323-31.

Westermann RW, Pugely AJ, Ries Z, Amendola A, Martin CT, Gao Y et al. Causes and Predictors of 30-Day Readmission After Shoulder and Knee Arthroscopy: An Analysis of 15,167 Cases. Arthroscopy. 2015;31(6):1035-40.

Jiménez Salas B, Ruiz Frontera M, Seral García B, García-Álvarez García F, Jiménez Bernadó A, Albareda Albareda J. Causes of unplanned admission after orthopedic procedures in ambulatory surgery. Rev Esp Cir Ortop Traumatol (Engl Ed). 2020;64(1):50-56.






Systematic Reviews