Surgery Made Simpler Thanks to Advanced Medical Developments

If you had gall bladder surgery 25 years ago, you might have had a hospital stay of up to a week. Between less-than-desirable hospital food and lack of sleep from constant interruptions, you'd be wishing you were home by the second day. Three long days after surgery, the painful needle in your arm would finally be replaced by oral pain medication. The entire ordeal would leave you exhausted.

But, thanks to improved technology, this type of surgery is often done as an outpatient procedure, allowing you to return home the very same day. Not only does it reduce medical costs, but it means less disruption of your busy schedule and the comfort of recuperating at home.

Increased medical knowledge has resulted in major new developments in surgery and anesthesia. A combination of factors, including advances in preoperative management, better antibiotics and less-invasive techniques allow more procedures to be performed as outpatient surgery.

Use of the laparoscope, an instrument with a lighted tube and magnifying lens, provides one good illustration. With a laparoscopy, the surgeon makes only small incisions, depending on the surgery, to insert the laparoscope. A tiny video camera is inserted so the surgeon can view the operative area on a video screen. The surgeon's hands remain outside the patient's body. With this device, they can remove gall bladders and perform other surgeries which used to be invasive.

Arthroscopy is another example of surgery made simpler. The surgeon can repair a shoulder, hand or knee joint using this procedure with only a small incision.

Advantages

In the recent past, exploratory surgery was often necessary to determine the patient's particular problem. That, too, has been greatly improved upon, due to advanced diagnostic methods. Today, when surgeons operate they generally know exactly what the problems are and the extent. Imaging techniques such as computerized tomography and magnetic resonance imaging have substantially lessened the need for exploratory surgery.

Large incisions used to be the norm, even for relatively simple operations. Now, incisions are considerably smaller, which makes the patient more comfortable and leaves a smaller, less noticeable scar.

Outpatient surgery is a win-win situation for everyone. Patients certainly prefer it, hospital beds are freed up for more serious patients and insurance costs are kept down. In addition, studies have shown that people undergoing outpatient surgery have fewer postoperative infections, possibly because they are not exposed to the germs normally present in and around hospitals.

Disadvantages

There are a few disadvantages to outpatient surgery. It's been estimated that one out of every 100 patients scheduled for outpatient surgery will require hospital admission. This could be caused by such factors as postoperative nausea or pain not relieved by oral medications.

Another possible disadvantage is decreased access to medical services.

Some feel greater patient responsibility is another downside. With hospital admission, almost everything is taken care of for you. That's not so, however, with outpatient surgery. Patients have to bear much greater accountability for their own care and in many cases family and friends must also take on duties.

Before the surgery

If you or a loved one is preparing for outpatient surgery, here's some useful advice to help things run smoothly.

Don't eat or drink anything (including water) for at least six to eight hours prior to surgery because your stomach must be empty when you receive anesthesia. This is to prevent vomiting, which can cause complications. If you do consume anything close to the scheduled time, it might cause a long delay.

Be sure to arrange for a friend or relative to come with you on the day of surgery or at least to drive you home. It can be comforting to have a companion, and besides the hospital staff probably won't let you drive yourself home. At some hospitals, it's not enough to arrive by yourself and tell the staff someone will pick you up later. They may delay the surgery until your companion/driver arrives.

Arrange for someone to stay with you at your home for at least 24 hours after surgery. You'll feel the effects of the anesthesia for at least that long, so you'll need someone to help make sure you get the medication you require, run to the drug store if necessary and prepare meals.

If you develop a cold, sore throat, cough or fever the day before surgery, call your doctor immediately. You may need to reschedule the appointment.

Be sure to bring all your medications to the hospital and don't take them at home before you leave. Wait until you've talked with the anesthesiologist who will consider possible drug interactions and decide what is safe to take.

If you have special needs, let the hospital know ahead of time. Such needs might include use of a wheelchair, walker or a visual or hearing impairment.

Avoid bringing valuables to the hospital. Although you are usually supplied with a locker, it's best to leave your money and jewelry at home.

If you are unclear about anything regarding your surgery, ask questions until you understand completely.

Post-operative care

You can expect to receive a sheet of instructions when you leave the hospital. Be certain you understand all the directions.

Some outpatient surgical units will call you on the day after surgery to monitor your progress and answer questions.

For the first 24 hours after surgery, you will need plenty of rest. Mild nausea is a common complaint, so resume eating and drinking gradually. Start with small sips of clear liquids. If you can tolerate liquids, move on to soft or bland foods such as crackers, noodles or rice. Avoid spicy or greasy foods for at least the first day.

It's not unusual to feel weak or tired when you leave the hospital, so don't plan to resume your normal activities for at least the first few days.

Remember, each person's recovery period is different. Someone with arthritis, for example, may have more pain or discomfort as a result of sitting or lying in certain positions after surgery.

Although you may not feel any pain, take your prescription medications anyway, as you might have received a long-acting local anesthesia which is effective for 12 hours.

An advancing field

Oddly enough, when the concept of outpatient surgery was first introduced, patients and physicians resisted it, but not any longer. Those early concerns about safety proved unfounded. Though there are risks with any type of surgery, if given the option, most of us would choose outpatient surgery.

As technology continues to advance, we'll see more procedures adapted to outpatient surgery. Perhaps someday, all hospital stays will be a thing of the past.

Common outpatient surgeries

Today, more than 200 procedures can be safely completed on a outpatient basis. Here are some common examples:

• Gall bladder surgery

• Breast biopsies and lumpectomies

• Hand surgery

• Tonsillectomy

• Eye surgery (such as cataracts)

• Hernia repair

• Lithotripsy

• Plastic surgery (cosmetic)

• Removal of cysts and moles

• Sinus surgery

• Varicose veins