Over the past 40 years, modern medicine has made remarkable advances transforming common surgeries — tonsillectomies, hernia repairs, gallbladder removals and knee surgeries — into outpatient procedures that send people home in a few hours. This development can provoke anxiety for patients and their loved ones as they find themselves in charge of taking care of increasingly complex medical recoveries that can include wound drains, nerve blocks and complicated medication regimens.
Some have criticized this trend, saying it places too much pressure on family and loved ones. But advocates say outpatient surgery saves money and gives patients what they want: a quicker trip home.
“Research has shown that patients recover faster in the comfort of their own homes,” said Rebecca Craig, a nurse who is the CEO of a Colorado ambulatory surgical center and president of the Ambulatory Surgery Center Association. She said good discharge instructions are the key to helping patients and caregivers “have the information and training they need to be successful at home.”
Patients' families do sometimes feel overwhelmed. A simple wound drain becomes more frightening when it's attached to your mother.
In 2013, nearly 20 million outpatient surgeries were done in hospitals or outpatient surgical centers. That’s five times the number in 1981, according to the medical research firm SMG Marketing Group. In 1983, there were about 200 ambulatory surgery centers across the country. Today, there are more than 5,000.
New Developments Allow for Quicker Recovery
Several factors contributed to this change. Better anesthesia allows patients to regain consciousness more quickly and with fewer side effects. Improved techniques allow for better pain control that is not completely reliant on opioids. Surgical advances, including laparoscopy, mean smaller incisions and less invasive procedures.
At the same time, the tremendous pressure on health care providers to reduce costs has fueled the trend.
But it’s not just the number of outpatient surgeries that is expanding. So is the complexity of those surgeries. In the past five to 10 years, new surgeries have been added to the list of possible same-day surgeries, including knee and hip replacements, spinal surgeries and some cardiac surgeries. This year, Medicare may decide to start paying for knee replacement surgeries done in outpatient surgery centers.
That increasing complexity means the job of caregiving following outpatient surgery is also increasingly complex.
Replacing a Nurse?
“It’s an awful, awful burden to place on people. Their role is to offer assistance, not to replace a nurse,” said Jean Ross, a nurse and co-president of National Nurses United (NNU). The NNU is a union and professional association for registered nurses that has been an outspoken proponent for liberal causes, including a single-payer health care system.
Ross fears the profit motive may push too many people home after surgery before they and their loved ones are ready.
But others say that patients and their caregivers can be taught to safely handle the new outpatient surgery cases.
“It’s all about education, and it starts when the person signs up for surgery,” said De’Ana Singletary, a nurse and administrator at St. Francis Hospital in Columbus, Ga.
What It Takes for a Successful Discharge
In a study published in Nursing Management, Singletary identified three key components to a successful discharge of a same-day surgical patient: realistic expectations by the patient, pain control and consistent discharge teaching.
Patients’ families do sometimes feel overwhelmed. A simple wound drain becomes more frightening when it’s attached to your mother.
But Singletary said it goes back to education of the patient and the caregiver in order to “provide that peace of mind at the front end.”
‘Lucky Enough to Have Had that Help’
Kristina Coppolino of Winter Park, Fla., relied on her mother and boyfriend for several days following same-day hip surgery last year. For two days, they helped her to the bathroom, prepared her meals, gave her medications and took care of her dog.
“They had to stop their lives to help me out. I was completely out of it for two days,” she said. “I’m lucky enough to have had that help.”
Her advice: Ask lots of questions. Knowing what to expect helped immensely during her recovery. Besides her surgeon, Coppolino also quizzed friends who had similar surgeries.
“Don’t be shy. Know what to expect. No question is unimportant,” she said.
5 Tips for Post-Outpatient Surgical Care
Here are five tips for caring for a loved one after outpatient surgery
- Find out what the procedure is. The difference between helping a friend after cataract surgery and knee replacement is massive. For the cataract patient, you may be just a short-term chauffeur. For someone who had hip or knee surgery, your roles may include driver, cook, bathroom aide, medication dispenser and overnight attendant.
- Take care of logistics in advance. Make sure you know where the surgical center is. Will your friend have the needed medications beforehand or will you have to go to the drugstore after the surgery? If he or she is wearing a leg brace, will your friend fit in your car? Is the house prepared for a healing patient? Clean sheets are a must and prepared casseroles in the refrigerator are a plus.
- Ask to go over the discharge instructions with the surgical center staff members. Make sure there are phone numbers to call if you have questions. Two key areas to cover: what to do about pain or nausea. Discharge instructions should also address how to care for the surgical incision. Look at the incision and dressing before you leave the center so you can monitor any changes in the first hours after surgery.
- Are there special instructions related to the surgery? Many post-surgical instructions for orthopedic surgeries will include details on the use of braces or if the patient is allow to bear their full weight on the affected leg. Depending on the surgery, there may be specific instructions on diet. Besides braces or crutches, learn about any other equipment. Some patients may leave with attached nerve block catheters or wound drains.
- Relax. Be present. Be calm. Most surgeries go fine. The gift of your time to help a friend in need is a special one.