Same-Day Outpatient Procedures May Be the Future of Hip, Knee, and Other Surgeries

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Experts say same-day outpatient surgeries help medical facilities by freeing up beds as well as healthcare professionals. Dean Mitchell/Getty Images
  • Both patients and hospitals benefit from shorter postoperative hospital stays.
  • More hospitals are shifting their focus to preoperative and postoperative procedures to shorten stays.
  • Insurance companies haven’t yet adapted, leaving some therapies uncovered.

Getting enough quality rest is important for your health, especially when you’re recovering from surgery.

But if you’ve ever stayed overnight in a hospital — with whirring machines, beeping alarms, and frequent check-ins —you might agree that it’s a place where rest can be difficult to achieve.

It’s one of many reasons that hospitals across the country have been working to shorten postoperative hospital stays.

At the 2022 annual meeting of the American Society of Anesthesiologists this week, doctors from Stony Brook Medicine in New York gave a presentation on how they improved their enhanced recovery after surgery (ERAS) program during the COVID-19 pandemic to shorten hospital stays.

Their findings haven’t been published yet in a peer-reviewed journal.

The research may lead some to ask: What are the benefits, who’s eligible, and what’s the financial impact?

Benefits of going home after surgery

“There are many benefits to patients spending less time in the hospital,” Dr. Rajeev K. Jain, a joint replacement surgeon at Northwestern Medicine Kishwaukee Hospital in Illinois, told Healthline.

“Eliminating the hospital stay means avoiding any contact with other sick patients that are in the hospital and this translates into less risk of infection for the patient. Rapid mobilization allows for a faster recovery, less pain, and a better overall outcome,” said Jain.

He says outpatient surgeries are more beneficial for hospitals, too.

“It frees up beds, resources, finances, and nursing staff to take care of sick patients,” said Jain.

The COVID-19 pandemic recently demonstrated how important empty beds and available resources can be for public health maintenance.

Of course, not every surgery can be an outpatient procedure. Sometimes staying in the hospital is necessary.

What determines who can go home on surgery day?

“There are two aspects of a patient that determines their candidacy for shorter hospital stays,” said Jain.

Medical safety is the first, he notes. If it would be unsafe to go home on the day of the surgery, doctors can make recommendations to help shorten the stay.

“The second determinant for a shorter postoperative hospital stay is the patient’s social situation,” said Jain.

He recommended designating a “coach” who can help you get to appointments, take medication, and contact your medical team if you have concerns.

Pre-habilitation and healthy living

Dr. William Wooden, the medical director at IU Health University Hospital in Indianapolis, and Nancy Strange, RD, a clinical nutrition specialist with IU Health, told Healthline that a shorter postoperative stay starts with thoughtful preoperative care.

“Many patients, and even many physicians, don’t recognize the power of ‘pre-habilitation,’” said Wooden.

“Ten or twelve years ago, most approaches dealt with what could be done in the hospital, and what could be done at discharge. Those things work, but more can be done during the short window between finding out you need healthcare and then receiving that healthcare to improve your outcome,” Wooden added.

IU Health implemented its “red bag” program several years ago, named for the red bags given out before surgeries. The bags contain a device to help improve lung strength, antibiotic soaps to prevent infections, and nutrient-dense drinks that support the immune system and wound healing.

“I used to spend about 90 percent of my time in one single general surgery clinic dealing with wounds that had not healed,” said Strange.

“That was down to less than 5 percent after we initiated the red bag program,” she noted.

Unhealed wounds don’t only delay going home but also additional treatments such as chemotherapy.

“Regardless of how healthy you are when you come in, this program helps everyone. If you’re very ill, it improves your outcome. If you’re very healthy and you just have something bad happen on your bicycle, it likewise can improve your outcome and your recovery,” said Wooden.

A healthy lifestyle — including regular exercise, healthy sleep, good nutrition, and not smoking — helps to improve your outcome, too.

“It’s not a magic pill. It’s a mental concept, it’s an access issue, it’s a lifestyle issue. How do we help America be healthier? Let’s proactively teach best health,” said Wooden.

Financial impact of preventive care

It’s been said an ounce of prevention is worth a pound of cure.

But when it comes to preoperative care, insurers don’t always see it that way.

“We have to work out getting this covered by Medicare, Medicaid, and insurance carriers,” said Wooden.

“They don’t cover wellness. They don’t cover nutrition education. We’ve created a program that’s instrumental in improving outcomes and quality of life after surgery, but I’m not generating income here because insurance doesn’t pick up my services,” said Strange.

“We can save up to 5,600 dollars per patient — that’s in cardiac care, as an example. Imagine how we can reinvest those dollars into your community,” said Wooden.

“The healthcare system in America is stressed. Hospitals are operating at 40 percent to 60 percent of the staff that they need. We’ve got to take care of as many patients as ever with better outcomes so they don’t need to come back,” he added.

“The idea is that we’re increasing capacity by getting patients healed more quickly. We’ve shown that this works, but if we really want to get it out to the public we need to start seeing it funded through insurance companies,” said Strange.

So what can you do for a speedier post-operative recovery?

“Ask your doctor what you can do before your surgery — or before your family member’s surgery — to improve your health and your recovery. Ask what you need to start doing right now and if there are any benefits to delaying the surgery,” said Wooden.

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