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Has Outpatient Surgery Become A Drive Thru Service?

May 21, 2008
Ah, the advances of medicine.

I recently spoke with a friend of mine that was diagnosed with breast cancer. She underwent a mastectomy a few days ago and I'd made plans to visit her in the hospital and provide care for her at her home. Imagine my surprise when she informed me that her hospital stay would consist of one night and that she planned to be up and about a few days after the surgery. She didn't plan to return to work for 4-6 weeks but told me that her surgeon's mother had recently undergone the exact same surgery and a few days later was working in her garden!

I had a similar experience last year. I had gallstones that were causing excruciating abdominal pain. As a result my doctor recommended gallbladder removal surgery. Do you know that as recent as 5 years ago this would have consisted of a 5" to 8" vertical incision from my ribs to my waist, 3-5 days in the hospital, and several weeks of recovery? Contrast that to modern day laparoscopic gallbladder surgery:

4 incisions are made in the abdominal area:

* 1 directly beneath the navel
* 1 on the right side of the abdomen (2 incisions)
* 1 beneath the sternum

The doctor inserts a laparoscope (a thin tube with a camera on the end) into one of the incisions and then inserts tools into the other three entry points in order to snip off and remove the gallbladder. If you have gallstones in ducts those gallstones are removed as well.

The hospital stay for laparoscopic gallbladder surgery is several hours. In other words, once the anesthesia wears off and you're able to walk steadily on your own they send you home. I arrived at the hospital at 6:30am and was wheeled out the door around 2:00pm. After settling in at home I took all of 2 pain killers and I was just fine. The next day I took some Tylenol and only had a little discomfort. I was back at work full time in 10 days. To be honest I could have returned earlier but my family insisted that I stay out a little longer. Even so, when I returned to work my co-workers were shocked that I was able to return so quickly.

I'm amazed that you can have a major organ or body part removed in the morning and be at home in your bed the same afternoon. On the other hand I sometimes think people undergoing traditional surgery (not laparoscopic) are being released from the hospital too soon. My friend that had the breast removed is doing just fine but I can tell you that when I had traditional surgery 5 years ago (to have yet another organ removed) I was released on Day Two, definitely too soon. I was barely able to walk from my bed to the bathroom but was given the "good news" that I would be going home that day. As a result I ended up in my doctor's office a day later because the incision had come apart.

Who's to blame when this happens? Are physicians under pressure from hospital administrators to free up hospital beds? Are insurance companies steadily decreasing the number of days they'll cover for hospital stays?

I sometimes wonder where we'll be in 10 years with this issue. As we make more progress with minimally invasive surgical procedures I can only assume the number of surgeries conducted using laparoscopic techniques will increase. Medical progress is unavoidable (and needed) but hospital stays will continue to decrease in duration as well, hopefully at a pace that's consistent with medical advances.

I can imagine this drive-thru scene:

"Welcome to Medi-King, may I take your order? Okay, I see you're having your gallbladder removed. Would you like to get a meniscal cartilage repair with that order?"
About the Author
Scarlett Moore writes articles that explore recent advances in gallbladder surgical techniques. Visit her site to obtain information on both traditional and laparoscopic gallbladder surgery procedures.
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