Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, October 5, 1993 TAG: 9310050144
SECTION: EXTRA PAGE: 6 EDITION: METRO
SOURCE: Jane Brody
DATELINE: LENGTH: Medium
Today, according to the New York State Society of Anesthesiologists, about\ 60 percent of operations are done on an outpatient basis: The patient arrives\ at the hospital or surgical center the day of surgery and goes home well\ before the next day dawns.
In a few years, the society estimates, two-thirds of operations will be\ such ambulatory procedures.
But just because an operation does not require an overnight hospital stay\ does not mean it is a totally safe and innocuous procedure. All operations\ carry risks both during surgery and for days and even weeks afterward.
Awareness of the possible hazards and proper preparation by the patient or\ a surrogate can help to forestall complications and to get prompt and perhaps\ lifesaving care when postoperative problems arise.
According to the results of the largest longterm study ever done of the\ aftermath of outpatient surgery, more than one-third of serious postoperative\ complications occur more than 48 hours after the procedure, well after the\ patient has left the watchful eyes of doctors and nurses.
The study, published in Wednesday's issue of The Journal of the American\ Medical Association, followed 38,598 adults who underwent a total of 45,090\ consecutive outpatient operations, with local or general anesthesia, at the Mayo Clinic in Rochester, Minn.
The patients or their surrogates were contacted both at 3 days and at 30\ days after surgery.
Thirty-three of the patients, or one in 1,366, experienced a\ life-threatening or fatal problem within the month after surgery, a rate the\ researchers considered to be "very low" and probably not much greater, if at\ all greater, than might have occurred had the patients not had surgery.
But the director of the study, Dr. Mark Warner, a Mayo Clinic\ anesthesiologist, cautioned in an interview that these findings should not\ lull people into complacency about the safety of outpatient surgery, especially\ since the study did not examine the rate of postoperative complications less\ serious than a heart attack or stroke.
"There are many nuisance problems that can occur postoperatively - pain,\ nausea and vomiting, low-grade fever _ as well as more serious problems like a\ spiking fever, lightheadedness and shortness of breath that might signal a\ serious complication," Warner said.
He noted that these complications can arise even in young, otherwise healthy surgical patients undergoing rather simple procedures.
Now, in response to financial pressures, outpatient surgery is being\ increasingly performed in older patients and people with underlying medical\ problems. As a result, the chances will increase for serious as well as pesky\ postoperative complications. And that means the responsibilities of the\ patient or the patient's surrogate will rise as well. Dr. Carolyn Greenberg,\ director of the Ambulatory Surgery Unit at Columbia Presbyterian Hospital in\ New York, points out that hospitals and surgical centers place limits on what\ they consider appropriate procedures and candidates for outpatient surgery.
Among the many types of operations now usually performed on an ambulatory\ basis are breast biopsies, knee surgery, hernia repair, tonsillectomy,\ hemorrhoid and cataract removal, vasectomy and tubal ligation.
Depending upon the procedure and the patient, it may be performed under\ local, regional or general anesthesia.
The limits on outpatient surgery are based on safety guidelines as they\ apply to the particular medical center. Patients and their families should\ never insist on having a procedure done on an outpatient basis if the surgeon\ or anesthesiologist recommends against it.
Jane Brody writes about health issues for The New York Times.
by CNB