Day-case anaesthesia in the elderly

Successful outcome from day surgery depends on good preoperative preparation, education of patients, day-surgery pathways, informed decisions regarding planned procedures, and postoperative care. Day surgery is widely accepted as the default position for the vast majority of patients requiring surgery, with inpatient stay chosen only by exclusion. Day surgery remains a good choice in the elderly, subject to appropriate home care after surgery. Patients should be assessed sufficiently ahead of the surgery to allow preparation, management of associated chronic diseases, and optimization. General anaesthesia may be associated with higher incidence of postoperative cognitive dysfunction, and it should be avoided as much as possible. Regional anaesthesia is the preferred choice when applicable because it provides good postoperative analgesia. Spinal anaesthesia is useful, but it can be associated with delayed discharge. A multimodal approach to pain relief and management of postoperative nausea and vomiting (PONV) are essential because inadequate management can significantly delay discharge.