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Ambulatory surgery is on an upswing

Like he’d undergone four years ago on his left side, Jared D’Aleo’s recent hernia operation on his right side was done as same-day surgery.

“I was under (anesthesia) at 3:30 and out by 6:30,” he said, with his wife, shortly thereafter, bringing him from the Center for Ambulatory Services at Vassar Brothers Medical Center in Poughkeepsie, to their Poughkeepsie home to recover.

D’Aleo has plenty of company. According to the Agency for Healthcare Research and Quality-sponsored Healthcare Cost and Utilization Project, ambulatory or outpatient surgeries, that is, those done where the patient is not admitted to a hospital, are on the rise. In fact, of the 26.8 million surgeries performed at the nation’s community hospitals in 2012, outpatient operations accounted for 17.3 million, or 65 percent, of them, a substantial increase over the 54 percent, or 12.3 million, outpatient operations performed at community hospitals in 1992.

Registered nurse Caryn Solomon, who is director of nursing, preoperative services at MidHudson Regional Hospital that has a same-day surgery center at its Poughkeepsie site, said ambulatory surgeries, where a patient returns home the same day the procedure is performed, are common and generally are less complicated than those requiring hospitalization.

“Ambulatory surgery is on an upswing,” Solomon said by email. “The Centers for Medicare & Medicaid Services (CMS) has approved additional procedures that can be done in the ambulatory setting. It is also more cost effective to do procedures in the ambulatory setting.”

While hospitals take on a large scope of medical issues and practices, ambulatory centers concentrate on a group of specialties and procedures, Solomon said. Other benefits include patients’ short stays and a high patient satisfaction rate from efficiency in procedures.

All same-day surgeries must be approved by the centers to be performed in an ambulatory surgery center, said Solomon, although not all patients are suitable candidates for the operations, with the person’s health status a prime consideration. Also key is the surgeon’s preference.

Medical doctor Martin Cascio, who is the medical director for the department of anesthesia at HealthAlliance Hospital in Kingston, said for most community hospitals, the vast majority of surgeries are ambulatory, including general surgeries, as well as orthopedic; plastic; urology; ear, nose and throat; obstetric and gynecologic and other operations.

“Returning the patient to their home environment as soon as possible has been shown to aid in recovery,” Cascio said by email. “Patients are more comfortable at home.”

Hospitals are great places of healing when needed, but there are negatives to a hospital stay, including an increasing risk of infection, he said.

“Some patients may view leaving the hospital on the same day as your surgery as risky, but the physician would not recommend it if they thought it would be unsafe in that patient’s situation,” he said.

Even so, he said, depending on a patient’s co-existing diseases, length of the procedure, expected postoperative pain, expected complications of the procedure and other factors, the same procedure may be done as an ambulatory operation for one patient and an inpatient surgery for another, where he’d stay overnight at the hospital.

“It is better for the patient to get up, move around and get back to a normal routine as soon as possible,” said Cascio. “This will speed recovery.”

Nowadays, improved surgical and anesthetic techniques have allowed for less postoperative pain and quicker returns home, said Cascio, including local anesthetics, peripheral nerve blocks and regional anesthesia.

“Surgical procedures that just a few years ago required a patient to be in the hospital for two or three days postoperatively are now being done on an ambulatory basis because of new techniques and a well-coordinated collaboration between surgery, anesthesiology, nursing and the surgical facility,” he said.

Kathy Hickman, a registered nurse and administrator of the Dutchess Ambulatory Surgical Center, a Poughkeepsie-based independent center accredited by the Accreditation Association for Ambulatory Care, said economic efficiencies and technological advances are driving more patients to the outpatient setting.

“Changes have occurred in health (care) that have allowed surgeries to be done more efficiently and quicker with the same result,” she said.

Because patients at ambulatory surgical centers come into them in a healthy state and aren’t exposed to the same level of contagions as are in a hospital setting, the infection rate for surgical procedures at the centers is lower, Hickman said.

“We don’t see sick people,” she said. “These are elective, pre-planned surgeries.”

With that, she said, because the Dutchess Ambulatory Surgical Center operates outside a hospital setting, where an emergency could unexpectedly push the time of a planned elective surgery out, all operations are done on time. As well, each patient is given specific discharge instructions for his or her at-home recovery, including points of concern that may require a follow up.

“If the patient has a lot of risk factors, such as diabetes or heart disease, he’s probably not a candidate for us,” said Hickman. “That’s more of a hospital setting.”

But for those that are good candidates for a same-day surgery, the process is smooth.

“Their loved ones can come with them in the pre-op and recovery areas,” she said. “It’s nice in terms of healing and recovery to have someone at the bedside when they wake up.”

D’Aleo said while he was at the Center for Ambulatory Services at Vassar Brothers Medical Center, he was assigned a tracking number that could be followed on displayed electronic screens, allowing his wife to see when he was in pre-op, surgery and post-op, which they both appreciated. And, while he went home in relative comfort since the anesthesia hadn’t fully worn off, two days later he was in a lot of pain at the incision site, with little relief from pain medication.

“They tell you to walk around because that relieves some of the stiffness, but it’s hard to get up,” he said. He’s expected to make a full recovery in about six weeks.

 

 

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