With improved technology and advances in anesthesia and pain control, many less invasive surgical procedures are now being performed on an outpatient, or ambulatory, basis. Common procedures that are now routinely performed on an outpatient basis include tonsillectomies, hernia repairs, gallbladder removals, some cosmetic surgeries, and cataract surgeries. Given the millions of procedures performed every year, complications from outpatient procedures are relatively uncommon.
Not all patients are candidates for outpatient surgery and some procedures still require hospitalization. A patient's medical history and the advice of the surgeon and anesthesiologist are important in determining if the procedure is best performed on an outpatient or inpatient basis.
The most appropriate procedures for outpatient surgery are those associated with post-operative care that is easily managed at home, and those with very low rates of post-operative complications, requiring care by a physician or nurse.
Outpatient surgery is performed in a variety of settings. Ambulatory care centers are located either within a hospital setting or as a freestanding satellite facility that is either independent or part of the local hospital. Some procedures may actually be performed right in the physician's office.
There are many advantages of outpatient surgery over traditional, inpatient surgery. These include the following:
Age, alone, is not a reason to disqualify an elderly patient from having outpatient surgery. However, age does affect the reaction of elderly patients to certain anesthetic drugs, as short-acting drugs often take a longer time to be excreted by elderly persons. Elderly persons may also have more underlying medical conditions that could make an outpatient surgery riskier. It is important for an elderly patient to have a thorough medical evaluation before any surgery to determine the best surgical setting for that individual.
The scheduled time of discharge depends on the type of surgery, the anesthesia used, insurance coverage, and the policy of the surgery center. In general, most patients go home between one and four hours after outpatient surgery. The anesthesiologist can give you more specific information based on your case. Occasionally, it is necessary for a patient to remain overnight. All ambulatory surgical facilities have arrangements with a hospital if this becomes necessary.
Patients who undergo an outpatient procedure should have someone to drive them home and stay with them following the procedure. Most patients are restricted from driving for 24 hours after surgery. Patients often experience drowsiness and minor after-effects, such as muscle aches, sore throat, and occasional dizziness and headaches. Occasionally nausea may also be present. There may also be fatigue and discomfort for a day or two following the surgery. This discomfort varies depending on the type of surgical procedure performed.
Once at home, the patient must be able to tolerate any pain from the procedure, with adequate pain management. Written and verbal instructions for proper pain management will be given and the patient must be able to follow these instructions. A nurse or the physician will generally follow up these instructions to make sure the patient is recovering normally. The patient will also receive telephone numbers to call if there are concerns or emergency help is needed.
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