Feasibility of day case varicose vein surgery in a district general hospital.

BACKGROUND: Day case surgery may reduce inpatient bed requirements, and varicose surgery may be an ideal operation to test the functioning of a day surgery service. AIMS: To evaluate retrospectively the feasibility of day case varicose vein surgery in all-comers, and to identify the risk factors for admission. METHODS: Over a three-year period from July 1995 to July 1998, all patients requiring varicose vein surgery had their procedure performed as a day case. A standard technique of sapheno-femoral ligation with below-knee stripping of the long saphenous vein and multiple stab avulsions of varicosities was performed. All limbs were dressed with wool in crepe bandage and were reviewed post-operatively at six weeks. RESULTS: Five hundred and forty two patients underwent varicose vein surgery, of whom 26% had bilateral varicose veins, 88% had primary varicose veins and 22% had recurrent disease. The procedure was performed under general anaesthesia in 86% of cases and under spinal anaesthesia in the rest. There was no peri-operative mortality. Ten patients (1.9%) developed post-operative complications. Seventy two per cent of patients were discharged on the day of surgery, a further 25% required admission for one night due to minor anaesthetic complications and patient preference. Four per cent required admission for more than 24 hours. The need for overnight admission was associated with the age of the patients (p < 0.0001), bilateral varicose vein surgery (p < 0.005) and the use of spinal anaesthesia (p < 0.01). CONCLUSION: Although varicose vein surgery is safe, acceptable and cost-effective as a day case procedure, if attempted in all-comers, overnight admission will be required in a significant proportion. Pre-operative selection is advised.

Effects of cold application on isometric strength and endurance of quadriceps femoris muscle.

This study was carried out to investigate the effect of cold therapy on isometric strength and endurance of the quadriceps femoris muscle group. Sixty volunteer healthy normal subjects participated in the study, 30 were males and 30 were females. They were aged between 20 and 27 years. The subjects were screened for previous knee injuries or abnormalities through history taking and physical examination. The baseline isometric strength and endurance of the quadriceps was tested before application of cold on the thigh. Immediate post and 10-minute post cold application isometric strength and endurance were measured using an adapted cable tensiometer. The result of the study showed that cold increased the isometric strength of the quadriceps in all the subjects immediate post and 10-minute post cold application (P < 0.05) and the immediate post cooling endurance index of male and combined male and female subjects (P < 0.05). No significant increase was seen in the immediate post cooling endurance for female subjects (P > 0.05). Also no significant difference was seen in 10-minute post cooling endurance of all the subjects when compared with the pre-cooling endurance. This study therefore concluded that cold application increased isometric muscle strength and endurance post cold application. It was therefore recommended that application of cold on muscle should be employed while rehabilitating an individual with musculoskeletal pathology or deficit particularly while training for muscle endurance, strength and restoration of muscle function.