Outpatient surgery, also referred to as ambulatory surgery, is surgery that does not require an overnight hospital stay. Patients may go home after being released following surgery and time spent in the recovery room .
Mounting pressure to keep hospitalization costs down and improved technology have increased the frequency of outpatient surgery, with shorter medical procedure duration, fewer complications, and less cost.
Due to improved pain control, advanced medical techniques—including those that reduce recovery time—and cost-cutting considerations, more and more surgeries are being performed on an outpatient basis. Surgeries suited to a non-hospital setting generally are those with a low percentage of postoperative complications, which would require serious attention by a physician or nurse. Outpatient surgery continues to mushroom: in 1984, roughly 400,000 outpatient surgeries were performed. By 2000, the number had risen to 8.3 million. A 2002 study reports that 65% of all surgical procedures did not involve a hospital stay. This statistic also reflects the fact that many patients (especially children) prefer to recover at home or in a familiar setting.
With increased technological advances in instruments such as the arthroscope and laparoscope, more physicians are performing surgery in their offices or in other outpatient settings, primarily ambulatory clinics and surgical centers, or surgicenters. Among the most frequently performed outpatient surgeries are tonsillectomies, arthroscopy, cosmetic surgery, removal of cataracts, gynecological, urological and orthopedic procedures, wound and hernia repairs, and gallbladder removals. Even such procedures as microscopically controlled surgery under local anesthesia (Mohs) for skin cancer have been recommended on an outpatient basis.
While many outpatient surgeries are covered by insurance plans, many are not. Candidates for such surgeries should check in advance with their insurance carrier concerning whether their procedures are covered on an outpatient basis.
Preparing for outpatient surgery varies, of course, with the surgical procedure to be performed. There are, however, guidelines common to most outpatient surgeries. Patients should be in good health before undergoing ambulatory surgery. Colds, fever, chills, or flu symptoms are all reasons to postpone a procedure, and surgical candidates should notify their primary health care physicians if such conditions exist.
Patients should check with their physician for all information covering preparation for outpatient procedures. A near-universal requirement is to have a family member or friend take charge of delivering the outpatient to surgery, either to wait there or to arrive in time to pick up the patient on release from recovery. The evening before, a light meal is recommended to preoperative patients, with no alcohol taken for a full day before surgery. Nothing is to be taken by mouth after midnight of the day preceding surgery. Smokers should stop or cut back on smoking prior to surgery. Loose-fitting clothing is recommended, and it is advised to bring enough money along to cover postoperative prescription drugs.
This same information applies if the outpatient is a child. If children are permitted clear liquids on the day of outpatient surgery, parents will be told when the child must stop taking them. Surgery will be cancelled or delayed if these requirements are not met.
The benefits of outpatient surgery include lower medical costs (one study sets them at 60–75% lower than comparable hospital procedures), tighter scheduling—because patients are not subject to the potential delays encountered in hospital operating rooms—and what many patients would consider a less stressful environment than a hospital setting. Recovery time spent in one's own home, either with familiar caregivers or home nurses, is a choice many postoperative patients prefer.
Complications related to surgery occur less than 1% of the time in outpatient settings. However, in terms of patient safety, non-hospital settings are not as regulated as are hospitals, so patients should inquire about potential risks concerning outpatient surgery that arise in ambulatory clinics, surgical centers, and physicians' offices. There are guidelines for surgery in outpatient settings, but oversight and enforcement may vary. In 2002, though 20 states required ambulatory surgical facilities to be accredited by one of three existing accreditation organizations, only half of these 20 states issued regulations on office-based procedures, and fewer still have established a system for reporting events in outpatient settings. Patients may wish to find out whether their outpatient center is licensed or certified as a medical facility, or is accredited, in the states that require this. The latter may be accomplished by contacting the Joint Commission on Accreditation of Healthcare Organizations.
Among problems encountered during outpatient surgery are those concerning anesthesia administration, infection, bleeding that calls for a transfusion , and respiratory and resuscitation events.
Lewis, C. "Sizing up Surgery." FDA Consumer Magazine (November–December, 1998). http://www.fda.gov/fdac/features/1998/698_surg.html .
Joint Commission on Accreditation of Healthcare Organizations. (630) 792-5000. http://www.jcaho.org/ .
Questions To Ask Your Doctor Before You Have Surgery. Agency for Health Care Research and Quality. http://www.ahcpr.gov/consumer/surgery.htm#head2/ .
Nancy McKenzie, PhD