Northwest Health Magazine Spring 2013 IssueNorthwest Health Spring 2013

In and Out With Same-Day Surgery

Less-invasive surgical techniques mean quicker recovery and fewer complications for patients.

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When a Seattle-area Group Health member recently had knee surgery for a miniscus tear, she arrived at the Group Health Medical Centers Capitol Hill Outpatient Surgery Center at 10 a.m. By 4 p.m., she was ready to go home.

"Some of my friends had this surgery many years ago," she remembers. "It was a big deal. They were in the hospital for a few days, had to have a large incision, and were on crutches for weeks. My experience was very different. I went home the same day without any complications from the anesthesia. I have scars from two tiny incisions. I was off crutches and went back to work four days later."

Knee surgery is only one of many procedures — from gallbladder removal to cataract surgery — that used to require a hospital stay, but is now done on an out-patient basis. In fact, today more than 60 percent of all surgeries performed are out-patient (also called ambulatory), meaning you'll go home the day it occurs.

While not a new concept, the shift to outpatient surgery has accelerated in the last decade or so. That growth is one reason why Group Health has three well-equipped and busy outpatient surgery locations: our Capitol Hill Campus in Seattle, our Bellevue Medical Center, and our Tacoma Medical Center. About 400 procedures are performed at each location every month in operating suites virtually identical to those in a hospital, by skilled surgeons in a wide variety of specialties. Commonly performed procedures include cataract surgeries; knee, foot and ankle, and shoulder surgeries; and complex thyroid surgeries.

For patients who get all their care at Group Health Medical Centers, that translates to a seamless experience. "With our coordinated system of care, a patient can be assessed in primary care and quickly referred to a surgical specialist. The specialist will evaluate the patient's readiness for surgery and can involve other medical specialists such as cardiologists or pulmonologists," says Steve Lavine, MD, a Group Health anesthesiologist and assistant medical director of Hospital and Perioperative Services.

"This is coordinated by our preoperative clinic to make sure the patient is completely ready for surgery," he says. Once the patient arrives at the surgery center, all of their medical information is available to all providers involved with the surgery, including the anesthesiology team, via our electronic medical records system.

Many Reasons Outpatient Surgery Is Better

The shift to outpatient surgery is fueled by improvements in anesthesia, surgical technology, enhanced imaging like MRIs, and medications that control nausea and pain.

Minimally invasive and noninvasive techniques are used, including laser surgery, laparoscopy, and endoscopy. These improvements have made surgery less complex and risky.

After surgery, patients regain consciousness more quickly with fewer aftereffects and with better options for pain relief than in the past. Recovery time is shorter so patients get back to work and activities more quickly.

Of course, some surgeries still require  a hospital stay, such as certain heart surgeries, and complex orthopedic procedures. But these are becoming the exception rather than the rule. That's a good thing for patients.

"If you don't need a hospital stay after surgery, that's better for you," says Dr. Lavine. "Any time you go for a hospital stay, infections can occur, even in the best of facilities, because unfortunately nothing is risk free." And obviously, most people would also rather recover in the comfort of their home.

Bob Lee, RN, Group Health's executive director of Perioperative Services, notes, "When it comes to patient satisfaction and safety, outpatient surgery has made a remarkable difference." The patient's family and friends benefit too, he says. There's no moving from floor to floor or from lounge to lounge like in a big hospital or medical center. "Unlike a hospital, you show up and it's all basically there in the same place — pre-op, surgery, and recovery."

How Outpatient Surgery Works

"For the most part, people who come to outpatient surgery are fairly healthy," says Jensine Winther, RN, a nurse anesthetist at the Bellevue Ambulatory Surgery Center. "But even those with ongoing health issues, such as a heart condition or diabetes, can often have outpatient surgery with the right pre-surgery work-up."

That includes ensuring patients have any additional necessary medical consultations prior to surgery, such as a review by a cardiologist, she says.

Nurse Barb Root, RN, who has worked in Group Health's Ambulatory Surgery Center in Tacoma for 10 years, says ambulatory surgery patients are given detailed instructions for how to prepare for the surgery, and it's important to follow them.

That includes not eating or drinking for a period before surgery, and leaving all jewelry — including body jewelry — at home. Vomiting food or drink can cause aspiration into the lungs, landing patients in the hospital, she says. Tongue piercings can come loose, and also migrate to the lungs if knocked loose by airways. "We really are all about safety," she says.

Most patients are sent home within a few hours after surgery. "But if a patient, for whatever reason, does not follow the expected course — for instance, if their vital signs need additional monitoring or they need more pain control — we can admit them to the hospital," Winther says.

Once they're home, a patient continues to be well supported. Along with detailed post-operative instructions, patients receive a phone call from a nurse the day after surgery to be sure they're progressing well. Winther adds: "There is so much support in the Group Health structure, we can send people home very comfortably after day surgery. We also have consulting nurses on call 24/7 — they're a really good resource for patients. It's positive on all fronts."

Winther knows intimately how well the system works from both sides of the equation: "I had outpatient surgery myself here several months ago, with my colleagues on staff. It was very pleasant and very efficient."

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