Outpatient Operations

The young Sacramento, Calif., housewife was understandably upset when her doctor told her that she would have to go into the hospital for a minor pelvic operation. She was afraid of surgery, nervous about the two children she would have to leave at home and concerned about the cost of her hospitalization. Instead of having her admitted the evening before surgery, as is customary, her physician asked her to report to Mercy General Hospital on the day of the operation. Once there, she was examined, given a sedative and wheeled into surgery. An hour later, she was in a recovery room. By late afternoon, after paying a hospitalization fee of only $28, she was home, elated to be back with her family so quickly.

The experience of the California housewife has become increasingly common as hospitals in growing numbers turn to outpatient (involving no overnight stay) surgery. That procedure, designed to cope with rising costs and the great demand for beds, was pioneered by the 258-bed Melrose-Wakefield Hospital in suburban Wakefield, Mass., which started its surgical "day care" program in 1969. Since then, outpatient surgery has become available in a growing number of hospitals around the country. In the greater Detroit area, for example, at least eight hospitals provide the service; eight more are planning to initiate it. Says Dr. Paul Lahti of William Beaumont Hospital in Royal Oak, Mich.: "In most cases, there is no valid reason for keeping a patient in the hospital any longer than is necessary to recover from the anesthetic."

Operations performed in outpatient programs include plastic surgery and some ear, nose and throat operations, as well as hernia repairs and minor orthopedic surgery. Many hospitals also find the outpatient approach ideal for the removal of benign tumors and cysts and early abortions. Even for those relatively minor operations, though, hospitals select their patients carefully, turning back the elderly or those with physical conditions that are likely to cause complications.

Once patients are accepted, the routines they follow are similar to those used at Detroit's Sinai Hospital. There, after preoperative tests are performed, patients are met by a "transporter," a young attendant in street clothes who escorts them to dressing areas. Then the patients are taken to surgery and later returned to a recovery room, where they wait until the anesthetic has worn off before being discharged in the care of a friend or relative.

Most physicians who have tried the new system find it somewhat more time-consuming than inpatient operations. Explains Dr. Patrick Jewell of St. John Hospital in Detroit: "We have to give detailed instructions. If there are minor complaints the first night, we have to handle calls from the relatives." But most agree that the majority of patients--and especially children--are likely to recover faster at home than in the hospital. They also point to the low complication rate from outpatient surgery. Says Sinai's Dr. Eli Brown: "A responsible parent who takes a kid home will probably watch the child better than he is watched in the hospital."

Some insurance companies are still reluctant to pay for outpatient operations; they equate them with office surgery, which is often not covered by medical policies. But most insurers are delighted with the moneysaving aspects of the idea. Hernia repair, for example, can cost an inpatient more than $600 in costs, exclusive of doctor's fees, at Detroit's St. John Hospital. An outpatient would pay only $301, most of it for the use of the operating room and the anesthesiologist's fees.

Although patients are also enthusiastic about the lower costs and welcome the opportunity to recover in their own homes, a few find that recovery disconcertingly rapid. One Detroit woman who told friends she was going to have a serious operation confessed to her doctor that she was embarrassed at being home so soon after surgery. Another complained that she returned home so quickly that it was days before her get-well cards caught up with her.

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