Outpatient surgery: risks, benefits and outcomes
Outpatient surgery is becoming increasingly popular. But what are its risks, and what does this mean for the future of health systems?
Outpatient surgery: Only advantages?
Ambulatory surgery centres (ASCs) usually have lower costs compared to hospitals. Patients can go home the same day of the procedure, so fewer overnight stays in hospital are required and there is less disruption to their daily lives. Since patients are only exposed to the hospital environment for a short time, the risk of infections (for example with hospital-acquired pneumonia) is lower in outpatient procedures. Patients generally report higher satisfaction with outpatient procedures, as waiting times are shorter, the procedure can be more personalised and recovery is faster.
Risks of outpatient surgery: It doesn't work without support
Although rare, complications can occur during or after outpatient surgery. These can include excessive bleeding, infection, anaesthetic-related complications and unintentional injury to surrounding tissue. Patients undergoing outpatient surgery must have a support system at home to monitor their recovery and respond to possible complications. Those who do not have adequate support may have difficulty with post-operative care, which increases the risk of complications.
Assessing pre-operative risk due to comorbidities is hugely important here. Some complex operations or patients with severe comorbidities may not be suitable for outpatient surgery. In such cases, traditional inpatient surgical procedures are required. Outpatient centres should also coordinate well with nearby hospitals to ensure a smooth process for complicated operations.
Is the outcome of outpatient surgery worse?
Numerous studies have reported favourable outcomes for patients undergoing outpatient surgery, accompanied by low complication rates and high patient satisfaction. Outpatient surgery has been shown to be safe for a wide range of procedures, from minor surgery to more complex operations such as laparoscopic cholecystectomy and hernia surgery.
In a meta-analysis, Bemelmans et al. looked at 41 studies involving 40,758 outpatient and 1,212,370 inpatient knee and hip procedures. The meta-analysis showed that outpatient surgery does not have an increased risk of complications compared to inpatient surgery. In addition, there was a significant cost reduction with outpatient surgery.1
Patients who undergo outpatient surgery generally recover faster, have less postoperative pain, and can return to their daily activities more quickly.
Outpatient surgery: A curse or a blessing?
Outpatient surgery offers many advantages, including cost efficiency, convenience, lower risk of hospital-acquired infections and higher patient satisfaction. While there are potential risks such as complications and problems with post-operative care, these are generally not significantly more common than in hospital and can be mitigated by proper patient selection and support systems. Research shows that outpatient surgery provides safe and effective outcomes for a wide range of procedures, such as orthopaedic surgery, making it an attractive option for patients and healthcare providers.
- Bemelmans YFL, Keulen MHF, Heymans M, van Haaren EH, Boonen B, Schotanus MGM. Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Arch Orthop Trauma Surg. 2022 Aug;142(8):1775-1791. doi: 10.1007/s00402-021-03811-5. Epub 2021 Feb 15. PMID: 33587170.