1. Common day-surgery procedures

Usually under local anaesthesia, with or without light sedation

• Excision of skin lesions, lipoma, cyst, small soft-tissue masses
• Minor wound surgery, drainage of a superficial abscess
• Carpal tunnel release, trigger-finger release
• Vasectomy
• Cataract surgery
• Minor dental and oral surgery
• Some varicose-vein procedures
• Breast lump biopsy or small breast procedures
• Flexible endoscopy, some diagnostic procedures
• Minor anal procedures, such as selected haemorrhoid treatments

Usually under general anaesthesia, sometimes regional anaesthesia

• Laparoscopic cholecystectomy in selected patients
• Laparoscopic inguinal or umbilical hernia repair
• Open inguinal hernia repair
• Appendicectomy in selected uncomplicated cases and established pathways
• Arthroscopy of the knee, shoulder, ankle, or wrist
• ACL reconstruction and selected other sports procedures
• Tonsillectomy and selected ENT procedures
• Septoplasty, some sinus surgery
• Hysteroscopy, diagnostic laparoscopy, selected laparoscopic gynaecological procedures
• Dilation and curettage, hysteroscopic polyp removal
• Ureteroscopy and removal of ureteric stones in selected patients
• Circumcision and selected minor urological procedures
• Simple mastectomy in appropriate settings

2. Which patient is suitable?

A. Suitable medical condition

• Stable health and comorbidities that are well controlled
• Adequate functional capacity for their usual activities
• Low expected risk of major bleeding, airway problem, severe pain, persistent nausea/vomiting, or need for prolonged monitoring
• A procedure expected to allow safe mobilization, oral intake when needed, and pain control using oral medication

• Controlled hypertension
• Stable diabetes with an agreed perioperative medication plan
• Well-controlled asthma or COPD
• Stable epilepsy
• Stable ischemic heart disease after appropriate assessment
• Obesity or older age, if associated conditions and airway/respiratory risk are appropriately assessed

B. Suitable procedure

• Low expected blood loss
• Low likelihood of serious cardiopulmonary instability
• No likely need for transfusion, ICU care, prolonged IV therapy, or close overnight observation
• Predictable postoperative pain and nausea control
• Low risk of urinary retention, delayed bleeding, airway swelling, or impaired mobility that would make discharge unsafe

C. Suitable social and home circumstances

• Understand the procedure, discharge instructions, and warning signs
• Give informed consent
• Have a responsible adult escort home and someone to stay or be readily available for the first 24 hours, according to local policy
• Have a telephone and access to transport/emergency care
• Live in a setting suitable for recovery
• Agree not to drive, operate machinery, drink alcohol, or make important legal decisions for at least 24 hours after general anaesthesia or sedation

3. Contraindications or reasons to plan overnight admission

Medical contraindications

• Unstable ASA III patient
• ASA IV or V patient, except in highly selected hospital-based pathways
• Any poorly controlled comorbidity, for example:
  • Uncontrolled hypertension
  • Unstable angina, recent myocardial infarction, decompensated heart failure, significant uncontrolled arrhythmia
  • Poorly controlled asthma/COPD or current respiratory infection with significant symptoms
  • Poorly controlled diabetes, severe hypoglycaemia risk, ketoacidosis, or major metabolic disturbance
  • Severe renal or liver dysfunction requiring close monitoring
  • Active sepsis or significant systemic illness
• Anticipated difficult airway combined with a setting unable to provide appropriate backup
• Severe untreated or poorly controlled obstructive sleep apnoea, especially with opioid requirement or major respiratory disease
• High aspiration risk not adequately managed
• Known severe postoperative nausea/vomiting risk when it cannot be appropriately prevented or treated

Surgical or anaesthetic contraindications

• Expected major blood loss or need for transfusion
• High likelihood of serious postoperative bleeding
• Major fluid shifts or prolonged complex surgery
• Anticipated need for strong parenteral opioids, prolonged oxygen, ventilatory support, or invasive monitoring
• High risk of airway obstruction, respiratory compromise, or aspiration after discharge
• Severe pain expected that cannot be managed at home
• Procedure requiring close neurological, vascular, urinary, or wound monitoring
• Inability to mobilize safely after surgery

Social contraindications

• No responsible adult escort or no safe caregiver arrangement
• Patient cannot understand or follow postoperative instructions
• No telephone, transport, or practical access to urgent medical help
• Unsafe home environment
• Very long travel distance from emergency services
• Patient refuses same-day discharge or is unable to participate in the plan

4. Main preoperative checks for the patient

1. History and examination
   • Heart, lung, kidney, liver, neurological disease
   • Diabetes, OSA, obesity, reflux/aspiration risk
   • Previous anaesthesia problems, difficult intubation, severe nausea/vomiting
   • Allergies and all regular medications
2. ASA status and functional capacity
   • Is the disease stable and optimized?
   • Can the patient safely manage activities at home?
3. Procedure-specific risks
   • Bleeding, pain, nausea, urinary retention, mobility, airway issues
4. Medication plan
   • Anticoagulants/antiplatelets
   • Diabetes medications and insulin
   • Antihypertensives
   • Steroids, anti-epileptics, inhalers, CPAP use
5. Fasting and discharge plan
   • Correct fasting instructions
   • Escort and adult supervision
   • Written advice, prescribed analgesia/antiemetics if needed
   • Contact number and return precautions

5. Discharge requirements after the operation

• Stable vital signs
• Awake or returned to their usual mental state
• Controlled pain and nausea with oral treatment
• No concerning bleeding or airway/respiratory problem
• Ability to drink if appropriate and mobilize safely for the procedure
• Passed urine when relevant, particularly after pelvic, urological, spinal, or high-risk procedures
• Responsible escort and clear written instructions