It is the best sum of all things. Outpatient surgery reduces healthcare cost, increases control of care, increases patient satisfaction and surgeon satisfaction. Everyone wins and it the best sum of all things.
At our outpatient surgery center, in a little over 4 years, the 5 of us have performed 6,000 outpatient hip and knee procedures. Evenly split female and male. Age range between 18 and 90. Some are partial knee replacements, but my oldest patient was a hip replacement.
The BMI ranges from very thin (16), to not very thin with a BMI of 66. BMI is not a contraindication.
These are not healthy patients. These are optimized patients without organ failure. Almost half of them—44%—had at least 1 major co-morbidity. Of those 94% were able to be discharged to their home the same day; 6% stayed overnight. About half of those, or 3.8%, stayed for a medical reason that needed to be managed overnight in our facility. Nineteen, or 0.3%, required transfer to an acute care hospital at the time of their surgery. And if you include those 19 and any complication that required unforeseen care within 48 hours, the rate was 1%. If you look at unplanned care, including all of those, it was 137 patients or 2.3%.
That is one-quarter of the rate that’s reported and that you will hear next from my colleague who is going to talk about opposing outpatient surgery.
By optimizing patients—call it cherry picking; call it skimming the cream—who cares? The rate of complication is one-quarter that of doing this within a healthcare system.
The post-op phone calls…are we just pushing the patient’s care out? Well, we’re not. We saw a statistically significant reduction in post-op phone calls to my clinic from outpatient patients versus patients who received care at the specialty hospital.
Are patients dissatisfied with this? No, they’re not. The rate of patients giving good to excellent is 98%, with zero patients saying they felt like they were pushed out of the surgery center too soon.
Yes, it is the best sum of all things.
In our experience, 2.3% 90-day readmission or complication rate, literally a quarter of what’s reported in the Medicare database; 98% good to excellent satisfaction on behalf of the patient and I guarantee you 100% satisfaction on the part of the surgeon.
