Outpatient Surgery

Definition
Purpose
Description
Preparation
Results

Definition

Outpatient surgery, also referred to as ambulatory surgery, is defined by the American Hospital Association (AHA) as “a surgical operation, whether major or minor, performed on patients who do not remain in the hospital overnight.” Outpatient surgery may be performed in inpatient operating suites, outpatient surgery suites, or procedure rooms within an outpatient care facility. Patients may go home after being released following the procedure and time spent in the recovery room.

Purpose

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 lower cost. As of 2006, about 53% of all surgical procedures in the United States are performed on an outpatient basis.

According to the Agency for Healthcare Research and Quality, about 90% of outpatient surgeries in the United States are performed to treat an illness or disorder; the remaining 10% are diagnostic procedures.

Description

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 nonhospital 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; and from 1993 to 2001, the number of freestanding ambulatory surgery centers in the United States increased by 150%. A 2002 study reported that 65% of all surgical procedures did not involve a hospital stay; this proportion is expected to increase to 75% by 2015. These statistics also reflect 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

KEY TERMS

Ambulatory surgery— Surgery done on an outpatient basis; the patient goes home the same day.

Ambulatory surgery center— An outpatient facility with at least two operating rooms, either connected or not connected to a hospital.

Outpatient procedures— Surgeries that are performed on an outpatient basis, involving less recovery time and fewer expected complications.

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 for skin cancer have been recommended on an outpatient basis.

Preparation

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. Medicare and Medicaid patients should also check whether these programs will cover the cost of their surgeries.

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 patient 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 patients should bring along enough money 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.

Results

The benefits of outpatient surgery include lower medical costs, 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 to recuperation in a hospital.

Complications related to surgery occur less than 1% of the time in outpatient settings. However, in terms of patient safety, nonhospital settings are not as closely 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. 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 (formerly the Joint Commission for 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 event. Some patients are at higher risk than others of requiring inpatient admission after an outpatient procedure. These include patients over the age of 65; operations lasting longer than 120 minutes; the need for general anesthesia ; and patients with heart problems, cancer, or vascular disease.

Resources

BOOKS

Fiebach, Nicholas H., ed. Principles of Ambulatory Medicine, 7th ed. Philadelphia: Lippincott Williams and Wilkins, 2007.

Joint Commission on Accreditation of Healthcare Organizations. Standards for Ambulatory Surgical Centers. Oakbrook Terrace, IL: JCAHO, 2007.

PERIODICALS

Bian, J., and M. A. Morrisey. “Free-standing Ambulatory Surgery Centers and Hospital Surgery Volume.” Inquiry 44 (Summer 2007): 200–210.

Eggertson, L. “Ten-Year Trend: Surgeries Up, Hospitalizations Down.” Canadian Medical Association Journal 176 (March 13, 2007): 756.

Fleisher, L. A., L. R. Pasternak, and A. Lyles. “A Novel Index of Elevated Risk of Inpatient Hospital Admission Immediately Following Outpatient Surgery.” Archives of Surgery 142 (March 2007): 263–268.

ORGANIZATIONS

American Hospital Association (AHA). One North Franklin, Chicago, IL 60606-3421. (312) 422-3000. http://www.aha.org/aha_app/index.jsp (accessed April 2, 2008).

Joint Commission. One Renaissance Blvd. Oakbrook Terrace, IL 60181. (630) 792-5000. http://www.jointcommission.org/ (accessed April 2, 2008).

OTHER

Questions To Ask Your Doctor Before You Have Surgery, Agency for Health Care Research and Quality. http://www.ahcpr.gov/consumer/surgery.htm#head2/ (accessed April 2, 2008).

Russo, C. Allison, et al. Ambulatory Surgery in U.S. Hospitals, 2003. Rockville, MD: Agency for Healthcare Research and Quality, 2007.

Wax, C. M. Preparation for Surgery.http://healthisnumberone.com/libsurgprep.htm (accessed April 2, 2008).

Nancy McKenzie, PhD

Rebecca Frey, PhD

Ovary and fallopian tube removal seeSalpingo-oophorectomy

Ovary removal seeOophorectomy