Day case discharges and criteria
A total of 860/1727 (49.8%) patients were discharged on the same day following nasal and/or palatopharyngeal surgery. One study was excluded from this analysis as the number of patients who were discharged on the same day was not clear (11). A total of 33 patients (1.9%) stayed overnight due to social reasons such as lack of transportation or at the patient’s request (8, 12, 13).
There was a lack of details across the studies on the number of planned day cases and the number of patients who were discharged on the same day due to good postoperative clinical parameters. Four studies did not report clear criteria for day cases (6, 11, 13, 14). Three studies reviewed patients post-operatively in recovery or the post-anaesthetic care unit (PACU) for desaturations prior to making a discharge decision (12, 15, 16). All the patients with mild or moderate OSA (defined as AHI ≤ 30) were day cases in one study (10) although it was unclear if this was predetermined. The remaining two studies based the discharge decision on the type of surgery and surgeons’ preferences (7, 8). Patients who had concurrent tongue surgery were usually admitted overnight for observation.
Four studies had a lack of data on intensive care or high dependency admissions among the inpatient group (6, 10, 13, 14). Two studies reported no ITU admissions (n = 83) among inpatients (12, 13, 15) of which one monitored all inpatients with continuous pulse oximetry overnight (15). All the inpatients of two studies (n = 323) were admitted to the high dependency unit or a similar ward set-up with a higher nurse to patient ratio and continuous pulse oximetry monitoring as a routine precaution (8, 16). Seventy five out of 216 (34.7%) inpatients of the remaining two studies were admitted to intensive care unit although the criteria for this was unclear and the level of intervention each patient received was unclear (whether it is for monitoring or if patients were kept intubated and ventilated) (7, 11).