Day-care plastic surgery in Nigeria: coping with limited resources

Background: The main problems facing acute surgical services in most countries are shortages of resources and finance, and long waiting lists. The concept of day-care surgery has been well established since the early nineties. Since then, enthusiasts have also indicated that day-care surgery represents a safe, cost-effective and efficient practice. Methods: A 3-year retrospective analysis of all day-care plastic surgical cases undertaken in the unit from January 2001 to December 2003 at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Folders of such patients were obtained from the hospital's medical records department. The information obtained was analyzed for demographic data, surgical problems, type of anaesthesia and postoperative complications. Results: A total of 148 procedures were carried out in 137 patients. This represented 37.2% of all procedures done and 36.5% of all patients treated within the same period in the unit. The ages ranged between 2 weeks and 58 years (mean = 23.1 years). There were 66 males and 71 females, giving a male: female ratio of 1:1.1. The most frequently performed procedure was lipomectomy (11.7%), followed by biopsy of skin tumours (10.9%), incision of tongue tie (10.2%), excision of breast lump (9.5%), reconstruction of facial structures (8.8%), ganglionectomy (8.0%) and others. The anaesthesia used was loco-regional with lignocaine in 92(67.2%) patients, intravenous ketamine in 41(29.9%) patients and inhalation anaesthetics in the remaining 4 (2 .9%). postoperative complications were observed in 13 (9. 5%) patients, the commonest of which was wound infection (8. 0%), followed by bleeding (5.1%), pain (5.1%) and haematoma (2. 9%). Readmission rate was 3.6%, mainly due to bleeding and delayed recovery from anaesthesia. Neither significant wound disruption nor mortality was recorded. Conclusions: Good preoperative patient selection and preparation are essential prerequisites for day-care plastic surgery especially in resource-limited environments like ours. It is safe and cost-effective