New anesthetic agents, combined with less-invasive surgical techniques, are allowing more and more patients safely to bypass the recovery room and even go home within minutes after surgery, according to Jeffrey Apfelbaum, M.D., vice chair of anesthesia and critical care at the University of Chicago Medical Center, speaking at the American Society of Anesthesiologists annual meeting.
At the University of Chicago Hospitals, more than 50 percent of patients having outpatient surgery recover quickly enough to leave the operating room in a chair and completely bypass the recovery room. Moreover, they are "awake, alert, comfortable, clear-headed, and have minimal, if any, pain or nausea," said Apfelbaum, a pioneer in the clinical testing and application of the newer anesthetics.
The trend will be to shift this approach from academic medical centers to community hospitals and clinics, and from clinics to private doctors offices, said Apfelbaum.
That shift is already underway. At the meeting, Apfelbaum presented a University of Chicago study involving five community hospitals or surgi-centers trained to implement the newer forms of anesthesia, using short-acting, fast-emergence general anesthetics, which allow patients to regain consciousness and alertness within minutes. His team found that 15 to 40 percent of patients who underwent outpatient surgery with new anesthetics were safely able to bypass the recovery room altogether, up from two percent or less before the study.
Speeding recovery time not only increased patient satisfaction, but also produced annual savings ranging from $50,000 to $158,000 per site.
"Better anesthesia and minimally-invasive surgical techniques have made it safe for many operations even some fairly complex procedures such as gall bladder removals, breast biopsies, and pacemaker placements to take place in doctors offices," said Apfelbaum. He estimates that seven to ten percent of surgery is already being performed in office settings.
"It's hard to predict where the trend will stop," he said. "It took years for patients and third-party payers to accept ambulatory surgery, yet today, 70 percent of surgery is performed on an outpatient basis."
He suspects that specialty areas such as pediatrics and geriatrics will move most quickly to take advantage of more rapid awakenings, which allows children to wake up to the comfort of their parents nearby, rather than feel surrounded by medical personnel in the recovery room. "Kids coming out of surgery would rather see Mom than some stranger like me in a white coat," said Apfelbaum.
Older people are particularly concerned about losing control and independence, even temporarily, he added, and appreciate regaining full awareness and mobility quickly after surgery.
Many surgical procedures today are performed with regional instead of general anesthesia. The technique is used to numb only a specific region of the body. Used alone or in combination with general anesthesia, it provides superior pain relief up to 36 hours after surgery. Combined with newer non-steroidal anti-inflammatory analgesics to relieve pain after surgery, the technique improves patient comfort by replacing or reducing the need for narcotics, which can impede recovery because they can cause drowsiness, nausea and other adverse side effects.
Apfelbaum believes the continued growth of office-based surgery will be driven by patient demand. "Patients want to get over whatever it is they're having done as quickly as they can, with little interruption in their normal lives," he said.