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A Journal on Forensic Medicine
Minerva Medicolegale 2004 March;124(1):23-32
Day surgery: medico legal aspects
Schillaci D. R., Pellegrinelli M., Morini O.
The process whereby medical assistance is reorganised along business lines encourages the institution of a new health model in which clinical effectiveness is wedded to efficiency in the use of resources. Answering to these needs is the introduction, within surgical disciplines, of treatments carried out on a day surgery basis. The analysis of situations of possible professional blame in such new surgical alternatives means keeping factors peculiar to day surgery firmly in mind. The present paper analyses the regulations that permit the introduction of day surgery. Special attention is paid to the type of structures in which it can be carried out, and the need to identify basic technical and organisational aspects, with close cooperation between the surgical team, the anaesthetist, the radiology department, the cardiologist, and analysis laboratory possibly in ''dedicated'' structures. Bearing in mind the personal series, peculiar aspects are dealt with regarding the careful selection of patients, the risks connected with the problems of timely clinical control for postoperative complications and the programme of periodic outpatient controls. The patient will have to give his/her consensus for surgery after careful assessment and information on the risk-benefit ratio with respect to other medical or alternative surgery solutions, considering the undeniable advantages but at the same time the need for adequate cooperation of the patient and the family physician for a prudent management at home and timely recourse to the day surgery structure in case of need. The suggestion is, however, that care should be taken before extending complex operations to the day surgery structure, a situation which might inevitably involve, in cases where the result is not completely favourable, a hypothesis of blame for the surgeon for negligence.