Are there advantages to performing surgery on an ambulatory basis?

Are there advantages to performing surgery on an ambulatory basis?

There are multiple advantages to performing surgery on an ambulatory basis. Most obviously, the patient returns much more quickly to the familiar home environ-ment. This is especially important for both pediatric and geriatric surgical patients. Formerly, patients might have remained hospitalized for days, rather than a few hours. A reduction in the acquisition of nosocomial infections has also been noted. This is an extremely important considera-tion when dealing with immunocompromised patients such as organ transplant recipients or patients who are receiving chemotherapeutic agents. Furthermore, in the ambulatory model, the incidence of medication errors related to either faulty prescribing or dispensing of drugs has decreased. In addition, overall costs are usually signifi-cantly reduced. This cost saving is due in part to a decrease in the number of laboratory tests requested and medical consultations obtained, as well as pharmaceuticals dispensed. Of course, the significant expense of both the inpatient hospitalization as well as the hospital facility fee is avoided. Other less tangible advantages include ease of scheduling procedures, without having to consider variables such as operating room block time, and an improved sense of patient privacy. This occurs because most offices are staffed by a small consistent group of personnel.

As a group, ambulatory patients tend to be more aware of the effects of the anesthetic they receive than the inpatient population. Because ambulatory patients usually undergo less intrusive surgical procedures and are less ill postoperatively, an attempt is made to resume usual preop-erative activities at an earlier time. Therefore, nausea, vomit-ing, myalgias, headache, as well as disordered sensorium and vertigo may appear to be more significant to this group of patients. Unpleasant symptoms are spontaneously reported with greater frequency than in the inpatient group, and patients may tend to focus their attention on them. These discomforting symptoms, if present postoperatively, may be recalled in a vivid fashion if an additional surgical pro-cedure is required. The negative recall may predispose the patient to extreme anxiety.

Only a small subgroup of patients may actually prefer hospitalization to ambulatory surgery.