In recent years, the number of outpatient surgeries has increased significantly. New surgical procedures, especially the so-called imaging techniques to assist in operations, but also innovative materials and devices make interventions in the human body increasingly easier.
Outpatient = more cost-effective?
In the wake of the need for hospitals to cut costs at every turn, outpatient surgery seems like a real alternative to expensive and lengthy hospital stays. But the equation “outpatient = short, uncomplicated and inexpensive” doesn’t easily add up. For a patient to be successfully operated on as an outpatient, a number of prerequisites must be met. Criteria for outpatient surgery include minimal risk of postoperative bleeding, minimal risk of postoperative respiratory complications, no special postoperative care needs, and the ability to receive fluids and nutrition quickly after surgery.
Which conditions are suitable?
The following conditions or procedures are particularly suitable for outpatient performance:
- Inguinal hernia
- Inguinal testicle
- Umbilical hernia
- Water hernia (hydrocele)
- Varicose veins
- Cataract
- Varicose vein hernia (varicocele)
- Arthroscopy (knee endoscopy)
- Gastroscopy
- Metal removal
- Bone fractures
- Interventions on the teeth
Care and aftercare
The patient must not only understand the procedure itself and its consequences, but in addition ensure that his transportation to the outpatient surgery is provided as well as his return home. His home must be equipped with light, heating, bathroom, toilet, and telephone. He must also be able to ensure that he can be reached and contacted either by himself or by a caregiver after surgery. For the time after the operation at home, it must therefore be ensured that the patient can receive immediate medical care in the event of possible complications. Aftercare – either in the practice or by home visit – must also be discussed and clarified in the preliminary consultation. The patient must be in good general health; pregnant women and infants should generally not be operated on as outpatients, or only after close consultation. The physician and the clinic where the outpatient surgery is performed must also be suitably equipped. The operating rooms, including the recovery room and monitoring facilities, must comply with legal requirements; appropriately trained operating and nursing staff must also be available. According to the guidelines of the German Society for Anesthesiology and Intensive Care Medicine (DGAI), a close connection to inpatient treatment options is required, as is a sufficient and easily accessible number of wheelchairs and parking spaces.
The preliminary discussion
Once the primary care physician or specialist has made the diagnosis of a condition requiring surgery and advised the patient accordingly, the first contact with the surgeon is made. During this discussion, patients should have the opportunity to discuss any questions without time pressure. The physician must conscientiously inform the patient about all aspects and check the necessity of any preliminary examinations. During this preliminary consultation, the date of surgery is then also set and all necessary instructions regarding anesthesia preparation are discussed.
The day of surgery
The anesthesiologists’ instructions regarding fasting and taking medications must be followed exactly. Anyone who feels ill shortly before the operation should definitely consult with the doctor again and, if in doubt, postpone the surgery date. The patient should be accompanied on the day of surgery by a trusted person, who is usually allowed to join him or her after the procedure. The duration of the aftercare period depends on the individual patient’s condition and is highly variable. For any waiting time both before and after the procedure, it is worth taking books, tapes and CDs with you.
The discharge
An outpatient is not discharged until circulation and cardiac function are normal for at least 60 minutes. The patient must be able to recognize the time, place, and known persons and dress and move appropriately for his or her preoperative condition. Nausea, vomiting, or lightheadedness should be minimal, as should minimal bleeding from wounds and no signs of inflammation.The patient must always be discharged by the surgeon and anesthesiologist, and appropriate instructions must be given to both the patient and the accompanying person for all relevant aspects of anesthesia and postoperative care. In addition, the patient must be provided with an emergency contact address and adequate pain medication.
Follow-up care at home
Those recovering at home after outpatient treatment often feel more comfortable there than in the hospital. Nevertheless, it should be ensured that help is available in the home and that a sufficient recovery period is observed. Even if the procedure was “only” performed on an outpatient basis, it should not be taken “too lightly.” An outpatient procedure is not automatically an “easy” procedure for the patient. Any questions or potential concerns or complications should be immediately addressed with the attending physician.
