Introduction

There is now a general consensus worldwide that daycare surgery offers many benefits for patients, doctors, insurance companies and employers. These include: reduced cost, increased convenience, increased safety and lower infection rates, providing a win – win situation for everyone. If this is true, then why hasn’t day care surgery become more popular in India, and what can we do about this?

I feel the problem is simple. The fact remains that many people are sadly still unaware of the major benefits which day care surgery offers. This includes the following key players: insurance company executives and patients.

Insurance executives are playing an increasingly important role in healthcare delivery in India today, thanks to their financial clout. Because many insurance companies still refuse to reimburse for surgery unless patients are hospitalised overnight, many patients are being admitted to hospitals just so that they can claim reimbursement from their insurance company. This is truly tragic. Interestingly, the true push towards popularizing day-care surgery in the USA came only when insurance companies started refusing to pay for hospitalization for procedures which they felt could be safely done on a day care basis, because they refused to pay extra for unnecessary hospitalization! Once insurance companies stopped paying for hospitalization, doctors started performing many more of these procedures on a day-case basis; and even hospitals started opening up Day-Care surgery units, so that they did not lose this important source of revenue! In India, instead of providing the impetus to catalyse this change which would save them a lot of money, insurance companies persist in taking an old-fashioned attitude. We need to concentrate our efforts on educating them and help them to keep up with the times!

Some patients (and their family members) are also worried about undergoing surgery in an Ambulatory Surgery Centre (ASC). Many of their fears are unexpressed, and they are worried about possible complications. Can the ASC deal with an emergency? Suppose a blood transfusion is needed or the patient needs to be transported to a hospital? What if there is a problem at home after discharge? Will the relatives be able to manage? Patients often feel more secure and comfortable in a hospital setting as they have been traditionally used to.

It is true that most patients are petrified at the very thought of having to undergo surgery, and one of the major worries is the fact that hospitalization is needed. After all, hospitals can be terrifying places for patients! We now need to explain to our patients that there is now a kinder option available for many patients who need to undergo surgery, which does not need spending time in hospital and this, is called day-care surgery (also known as ambulatory surgery or same-day surgery).

Day-care surgery has become increasingly popular all over the world for many reasons. First, thanks to tremendous advances in technology, many doctors have started performing minimally invasive surgical procedures.

These procedures use endoscopes, and require very small incisions, so that the risks involved in conventional major surgery can be avoided. Secondly, the newer drugs used for anaesthesia allow patients to recover consciousness very quickly, so that they can go home soon after the surgery is over. Finally, modern painkillers are safer and more powerful, patients have much less pain after the operation and they themselves can take these medications at home.

Ambulatory surgery allows patients to recuperate where they are most comfortable—in their own home! This is now a global trend, and over 70% of elective surgery in the USA is now done on an ambulatory basis. This fact is not surprising; given the various benefits ambulatory surgery offers patients. Patients find day-care surgery much less stressful, as short recovery times allow anxious patients to be comforted soon after surgery by their relatives and they don’t need to be isolated in a hospital room. Moreover, patients do not suffer from separation anxiety, as they do not need to be separated from their families overnight — something which is especially helpful for children. Ambulatory surgery means less time away from home, less time off from work, and less disruption of the patient’s schedule. Patients are happier, because they remain in a single unit which has been planned, and is operated, solely for their safety and comfort. Patients prefer ambulatory surgery over hospital outpatient departments because the former involves less paperwork, little waiting and more organized and friendlier staff compared to crowded and uncomfortable hospital settings, where, day care surgery patients get low priority, because their surgery is usually scheduled last, after the major operations.

Studies worldwide have shown that ambulatory surgery delivers the same high-quality care as that given to hospital patients. The first ambulatory surgery centre was setup in the USA in 1970. Today, almost seven million surgeries are performed each year in the more than 2,400 surgery centres across the United States. While day-care surgery is still a very new concept in India, it is heartening to observe that is becoming increasingly popular day-by-day.

Because the expenses incurred during a hospital stay are eliminated, ambulatory surgery usually costs less than the same type of surgery done for a hospital inpatient. This is a benefit that everyone — insurance companies, business organizations, surgeons and patients — greatly appreciate! Day-care surgery centers, provide high-quality health care at lower costs compared to hospitals because they maintain low overhead costs and also because they can focus only on aspect: treating ambulatory patients efficiently. On an average, procedures at ambulatory surgery centres cost 47 per cent less than those at hospitals. (This figure is based on a study conducted by Blue Cross / Blue Shield of North Carolina).

Some patients still prefer undergoing surgery in a large hospital, because they feel it is safer in view of the backup facilities the hospital can provide in case of an emergency. Paradoxically, day care surgery centres are actually safer because they are dedicated to performing only ambulatory surgery, so that there are no “sick” patients; and there is no risk of acquiring hospital - generated infections. In a surgery centre, patients receive more individual personal care as compared to the impersonality of a large hospital. Ambulatory surgical units have achieved an excellent record throughout the world, with a very low incidence of complications, because of careful patient selection; and adequate back-up facilities to meet any emergency. Of late, patients and surgeons alike are increasingly, learning the benefits of outpatient surgery centres. Healthy patients find such centers much more comfortable than hospitals, which are primarily designed for the very ill. Family members also prefer day care surgery, because they can take care of the patients themselves, rather than leave them in an impersonal hospital room. Surgeons also find scheduling their outpatient activities much easier at an ambulatory surgery center, because problems with hospital waiting lists or booking a hospital room do not exist. They also find that since the cost of a hospital stay is eliminated, they can provide quality care to their patients at a lower rate.

Many factors, including medical advances, patient awareness and economics are the primary ‘driving force’ behind the growth in ambulatory surgery centres. All aspects considered, ambulatory surgery is likely to become an increasingly popular option in the future! We need to sell the idea – we need to market it!

Patient satisfaction is a hallmark of the day-care surgery industry. The U.S. Department of Health and Human Services Office of the Inspector General surveyed Medicare beneficiaries who had one of four procedures in a day-care surgery centre. He found that 98% of the people were satisfied with their experience. One reason for high patient satisfaction is convenient scheduling. According to FASA’s Outcomes Monitoring Survey, 75% of day care surgery centres started more than 80% of their cases on time. Patients also choose day care surgery centers for their high level of professionalism and safety.

Maintaining a competitive edge has become imperative in today’s health care climate. Those striving to survive in this rapidly changing marketplace must be proactive to the changes that occur. The doctor owned Ambulatory Surgery Centre (ASC) has proven itself as an efficient, productive and patient friendly means of performing common, low risk outpatient surgical procedures. Running an ASC can help doctors remain independent, profitable and contented.

#Printed with the permission of the Editor, Day Surgery Journal of India *Malpani Infertility Clinic, Colaba, Mumbai. India.