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There are a number of reasons that more procedures will continue moving out of the inpatient surgery departments and into outpatient settings, says J. Lance Lichtor, MD, president of the Society of Ambulatory Anesthesia in Park Ridge, IL, and a professor of anesthesiology at the University of Chicago Hospitals.
Technological changes that have improved optics that are used with laparoscopic equipment are a key change, Lichtor explains. Surgeons will be able to perform more complicated procedures that previously have meant inpatient stays, he adds. (For more on emerging technology, see Same-Day Surgery, March 2001.)
Anesthesia also will play a big part in the ability to move procedures into same-day surgery, explains Lichtor. "There are three key reasons patients stay in a hospital after surgery: pain, postoperative nausea, and vomiting, and slow return of normal body functions," he says. The options for pain management now include sending patients home with catheters and pain medication, Lichtor says. (For more information about post-surgical pain control, see Same-Day Surgery, February 2001.) "There is also greater use of epidural and regional blocks that provide longer-lasting pain control," he adds.
Technology and improved pain control have increased the number of orthopedic procedures handled by same-day surgery within the Henry Ford Health System in West Bloomfield, MI, says MaryAnn Edwards, RN, MSA, supervisor of ambulatory surgery at Henry Ford Health System. Another factor that will contribute to the increase of same-day orthopedic procedures is 23-hour stay units, adds Edwards. "A 23-hour unit greatly expands the range of cases in most specialties you can schedule for ambulatory surgery," she says. (For more about 23-hour stay units, see Same-Day Surgery, August 2000.)
The most common reasons for an unanticipated inpatient stay are postoperative nausea and vomiting (PONV), pain, and slow return of normal body functions, says Lichtor. PONV is related to a number of factors including the procedure itself and drugs, Lichtor points out. There is a growing awareness of the value of antiemetics in the recovery room for patients who may be at high risk for PONV, and there are great advancements in antiemetic and pain control delivery systems such as patches, he adds. (For more on handling PONV, see Same-Day Surgery, July 2000.)
Enabling the body to return to normal function also has improved with the use of fast-acting anesthetics and epidural anesthesia that don’t prevent the bowel and kidneys from functioning soon after surgery, Lichtor explains. "Five years ago, we administered general anesthesia for abdominal surgery, but now we use a combination of regional anesthesia and newer anesthetics. This technique works well and allows the body to recover more quickly," he adds.
Lichtor explains the movement of procedures out of the hospital doesn’t just mean movement to same-day surgery programs or centers. "More procedures can safely be done in an office setting if the surgeon has the proper equipment," he says.
While the cost of laparoscopic, anesthesia, and radiological equipment needed for more complex procedures may be cost-prohibitive for individual physicians, groups of physicians may see the value of purchasing the equipment together, he says. "In this situation, surgeons may perform the procedure in their office, then send the patient to a recovery center that operates like a hotel," he adds.