S12 2. Surgery 1""7 1381 Quality Indicators In Ambulatory Surgery In General Surgery, Analysis of 7 years of experience In Fundacl6n Hospital Alcorc6n P. Hernandez, J.A. Rueda, C. Fiuza, A. Alvarez, C. Loinaz, A. Quintans. Fundaci6n Hospital Alcorcon, Madrid, Spain Objective: To analyse the results in Ambulatory Surgery (AS) in General Surgery Unit from 1998 to 2004, with special remarks in cancellation rates, unplanned admission rates, preoperative mean stay and postoperative mean stay. Patients and Methods: All patients operated on AS in General Surgery Unit from 1998 to 2004 were included in a register. Data included were: sex, type of anaesthetic technique, diagnostic, cancellation rate and their causes, and unplanned admission rates and their causes. In our centre, AS was designed as an activity, not a Unit, Operating rooms and surgical programme are shared with in- patient surgery. All surgeons and all anaesthesiologist perform AS. The timetable of surgery was from 8.30 am to 3 pm. In 2004, began an afternoon surgery programme and timetable was prolonged to 8 pro. Results: In this period, we have operated on AS 5288 patients (46.2% of elective major surgery, excluding minor surgery). The rates each year were: 1998=42.3%; 1999=48.6%; 2000=46.8%, 2001 = 46.3%, 2002 = 46.6%; 2003 = 47%; 2004 = 46%. More frequent pathologies were: 1426 inguinal hernia, 1357 vascular access for haemodialysis, 975 pilonidal cyst, 342 anal fissure or fistula, and 325 umbilical hernia. Local anaesthesia was used in 60% of cases, regional enaesthesia in 30% and general anaesthesia in 10%. Cancellation rate was 8% and the year evolution was 1998 =7.4%, 1999=9.2%, 2000=7.8%, 2001=8.6%, 2002=8.3%, 2003=6.3%, 2004=7.7%. More common causes were: no-show patient 47%, illness 15%, mad insufficient surgery time 14% Unplanned admission rate was 6.5%, and each year rate was: 1998 =6.1%; 1999=8.6%; 2000=7.7%; 2001=6.1; 2002=5.3%; 2003=2.7%, 2004=8.8%. Causes of unplanned admission were anaesthetic in 38% (urinary retention and hypotension, the more common) and surgical in 38% (more extensive surgery and pain). Mean stay at the Unit was 441 min (median 404min) mad mean postoperative stay was 198 rain (median 189rain). Inguinal hernia had the most prolonged postoperative stay (440min) and pilonidal cyst had the least (87min). Conclusions: AS rate remains stable around 46%. Cancellation rate was stable and no-show patient was the main cause. Unplanned admission rates were higher in 2004 due to afternoon surgery programme. We need to perform modifications in our policy to improve our figures. sickness was present in 35% & 29% of the respondents before leaving the hospital and on 1st post-operative day respectively. Pain was less or equal to what was expected in 80.5%. Twelve percent and 36% patients consulted their GP for pain and wound respectively. Ninety four percent of the respondents was very satisfied and would have similar operation as a day case surgery in future. Conclusion: Day case laparoscopic cholecystectomy is a safe and effective service with high patient satisfaction. 1401 Thyroldectomy In ambulatory surgery and ovemlght stay surgery W. V~squez, E Rniz, J.M. Asencio, E. Bastida, S. Agusti, M. ZabaUos, J.R. Polo. Hospital Uniuersitario Gregorio Marah6n, Madrkl, Spain From January 2004 to January 2005, 90 thyroidectomies were performed at the 3rd Service of General Surgery. 72 out of 90 were performed in the afternoon and discharged from the hospital the following morning after surgery (unilateral lobectomies and total thyroidectomies). In this group of overnight stay discharge after the operation varies from 14 to 18 hours. Drainages were removed before discharge in all the patients. Patients with total thyroidectomy were discharged with routine prophylactic treatrnent for temporary hypocalcemia- (Oral calcium and calcitriol). PTH was performed the day after surgery and the aforementioned treatrnent was modified according to the PTH level. 12 patients were operated on at the Ambulatory Surgical Unit under general anesthesia. All the patients had thyroid nodules with low risk for carcinoma (between 20 and 60 years of age, less than 5 cm of diameter, and cytolosy without signs of malignity). Intraoperative pathology was not performed. Possibility of a second operation for completion thyroidectomy, in case of definitive malignity, was discussed previously with the patient. Patients were discharged between 4 and 7 hours after surgery. In all cases definitive pathologic studies confirm the absence of malignity. No complication was observed in this group of patients. After gaining more experience with unilateral lobectomy, selective cases of total thyroidectomy should be considered in the future. [• Antibiotic prophylaxis for hernia repair with P.A.D. technique [3m39_9_] Effectiveness and patient satisfaction of day case laparoscoplc cholecystectorny D. Bandyopadhyay, S. Herpe, S. Moorehouse, B. Khan, C.R. Kapadia, E.P. Dewar. Airedale General Hospital, UK Objective: With the advencament of anaesthetic techniques, facilities of day surgery unit and increase in surgical experience, we aim to assess the effectiveness and patient satisfaction of day case laparoscopic cholecystectomy. Method: All patients fulfilling day surgery criteria were included in the study over a specified time period of 6 months. Anaesthetic techniques and post-operative advice were staudardised. Incidence of inpatient stay was analysed. A postal questionnaire was offered to the day case patients about adequacy of pre-operative information, pain and sickness before discharge and on 1st post-operative day, expectation of pain at home, reasons for GP consultations following discharge and overall satisfaction. Results: Eighty one palients were admitted for day case laparoscopic cholecystectomy. Six patients (7.4%) were not discharged from the day unit because of late surgery and recovery in 3, and pain and vomiting in another 3 palients. Response rate to the questionnaire was 83% Ninety five percent of the respondents were happy with the pre-operative information. Pain was nil/mild in 52%&72% and E. Bamglia, G. Bonotto, E. Caronia- Hospital Oderzo, Italy The aim of this study is to determine whether the use of prophylactic antibiotics is effective in preventing postoperative wound infection in mesh inguinal hernia repair. From March 2003 to November 2004, 213 male patients with primary inguinal hernia were operated according Valenti's P.A.D (Self-regulating dynamic prosthesis) technique in Day Surgery (89% pts. in local anesthesia). In this series were excluded recurrent hernias, bilateral hernias,femoral hernias, ingulnoscrotal, ASA > 2, hernia with operating time more than an hour, and situation at risk such as diabetes and obesity. 98 patients (mean age 59.2, range 24-83) received a single dose of 2g of cefazolin preoperatively. The control group consisted of 115 patients (mean age 59.4, range 19-92). For both groups the mean operative time was 45 minutes. Patients were controlled at one week and at one and two months. None patients of the antibiotics series developed wound infection. Only one patients of the control series developed infection, confirmed by coltural test. No seroma occurred in both groups. The Fisher's exact test showed no significance (0.54). Although in literature a recent Cochrane meta-analysis (2003) concluded that antibiothic prophylaxis for hernia repair cannot be firmly recommended or discarded, we conclude that, in our experience, prophylaxis is of no benefit to low risk patients undergoing inguinal primary hernia with P.A.D. technique.