If we look at postoperative respiratory depression, many of these people have obstructive sleep apnea.
And if you look at the reported incidents, about 23% in females and nearly half the males. And we know the risk of respiratory complications in OSA patients consuming opioids in the early postoperative period is substantial. Risks: hypoxia, pneumonia, and death in those patients. Post-op urinary retention. If undiagnosed and not treated in a timely fashion, we all know this can lead to permanent bladder damage, hydronephrosis, chronic UTIs, etc.
I know outpatient surgery can be done safely in selected patients. Larger studies, however, are required to clearly define proper patient selection and safety.
My fears are major complications at an ASC located distant from an acute care hospital, the effect of surgeon ownership possibly leading to poor patient selection, and increased resources are required to do this, and many surgeons don’t have that to provide the extensive preoperative education as well as the close post-operative surveillance that is necessary to ensure success in these patients and for this reason probably not yet ready for widespread use.
Moderator: Thanks, Doug. Adolph, one-minute rebuttal.
Dr. Lombardi: In 2003, I decided that we were going to move from a downtown hospital to a specialty hospital. We built a specialty hospital out in the community and they don’t have an ICU.
From 2003, I’ve done 95% of my surgeries at a specialty hospital that doesn’t have an ICU. It does have an intensivist. I understand transferring a patient to an acute care hospital. That hospital is about 5 to 8 miles away, they come pretty quickly when you call them whether we’re calling from the hospital or from the surgery center.
I go on my rounds the next morning on my Medicare patients, they’re up, talking, eating, ready to go home. You wonder why they really had to spend the night. And we also looked at one year’s data and we hadn’t transfused a single knee patient in that whole year. And we transfused only two women who presented for hips and their hemoglobin was less than 12.
You’re putting your head in the sand if you think outpatient surgery is not here now and CMS [Centers for Medicare and Medicaid Services] is going to change the rule come next year. They’re all going to be outpatients.
Dr. Dennis: I agree a lot with what Adolph said. He’s a highly skilled surgeon, he has an unbelievable staff that works with him. He has really created a wonderful center. I’m not sure everybody can go ahead and duplicate some of the numbers he is showing.
I understand this is coming. I’m starting to do it. Typically, my first two cases of every day I’m doing in a hospital setting are going home that day. We pre-select them.
But I still don’t think that we have all of the preoperative evaluations done in a scientific way to really know which ones are okay and which ones are not. If it’s one in a million and you’re the one, that still every bit as devastating.
