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Summary

Outpatient surgery (also referred to as ambulatory surgery, same-day surgery or office-based surgery) is a surgical procedure where the patient is allowed to return home on the same day as the procedure rather than stay in a hospital overnight. Outpatient surgery can be performed in a hospital or in a doctor's office. 

Surgeries suited to outpatient status are those with a low percentage of complications after the operation which would require serious attention by a doctor or a nurse. 

To maximize chances for success, it is helpful to know questions to ask and steps to take before outpatient surgery, how to prepare once surgery is scheduled, what happens during an outpatient procedure, what to expect if the procedure will be performed in a hospital, and what happens when you get home. Each of these subjects are covered in other sections of this article.  

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NOTE:  If you are sick with multiple medical problems, consider having all outpatient procedures in a hospital outpatient setting. Multiple medical conditions generally increase the risk of surgery. 

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Questions To Ask Before Agreeing To Outpatient Surgery

With respect to the surgery

  • Ask the same questions about the procedure you would before agreeing to any surgery. For a list of questions to consider, click here.
  • Check the surgeon's credentials. To learn how, click here.

With respect to the facility

As a general matter, complication rates are low for outpatient procedures. Complications related to surgery occur less than 1% of the time in outpatient settings. However, it is important to check to find out what procedures are in place where the outpatient procedure will take place in case there is an emergency and additional medical skills and/or equipment is required.

  • Ask your doctor about your "physical status classification." The American Society of Anesthesiologists uses a numerical scale to assess a patient's surgical risks. In general, patients with a lower PS score of one through three are good candidates.  (One means generally healthy.  Three indicates a serious disease that is not life threatening.) It is generally advised that patients with a higher number have procedures performed in a hospital setting.
  • Check the facility
    • What is the accreditation/certification of the facility in which the surgery will be performed?
      • Is the facility accredited by an independent accrediting agency?  In addition to asking the doctor or nurse, you can check the following websites: 
      • Is the group certified by Medicare? (the doctor or facility can answer this question for you)
    • Who owns it?  If t he clinic is owned by your doctor, be wary. There is a conflict of interest and the clinic may not be your best option.
    • If anesthesia will be provided so that you will not be awake during the procedure:
      • Who will provide it? What are the person's medical credentials and experience? Particularly look to find out whether the person is board certified.
      • Will the anesthesia be local or general? (General is when you are rendered unconscious). 
      • If anesthesia will be general, how will I be monitored?
    • What steps are taken to prevent infection?
    • Is the recovery area staffed by a nurse?
    • What arrangements are available in the event of an emergency?  For example: 
      • Is there a so-called "crash cart" (equipment and drugs that are used for cardiac emergencies) on site? 
      • What plans are in place to transfer patients to a hospital if necessary? 
      • How far away is the nearest hospital emergency room?  Does the doctor have privileges in that hospital?
      • NOTE: If the procedure will occur in a hospital setting, the resources of the entire hospital are available in case of an emergency. Non-hospital settings are not as regulated as hospitals.
  • Ask about pain management. Some doctors do not order strong painkillers on an goinging basis. 
  • Think about payment.
    • If you have health insurance:
      • Check with your insurer to see that the procedure is covered. While many outpatient surgeries are covered by insurance plans, many are not. Some insurers may require hospitalization before a procedure is covered. 
      • Find out what you may be expected to pay out of-pocket, such as for co-payments. 
      • If your insurance would cover if the procedure is done in a hospital but not in a non-hospital setting:
        • First, find out the difference in cost for performing the procedure in a hospital outpatient setting compared to a non-hospital setting. 
        • Then, contact a supervisor in the insurance company. Explain how much less expensive it is for the insurer if you do the surgery on an outpatient basis than if you are hospitalized. 
        • If the insurer refuses, you can ask to have the surgery performed in the hospital setting.   
    • If you do not have health insurance, or your health insurance does not cover the procedure, ask:
      • How much will the procedure cost? 
      • Is the doctor willing to negotiate price?
      • Can you pay in installments?
      • Does the doctor work with a company that finances procedures?
      • Read the Survivorship A to Z article about obtaining surgery without health insurance
  • If you develop complications, who do you contact and how can you make contact 24/7?

How To Prepare For Outpatient Surgery

  • Scheduling an outpatient procedure: 
    • It is preferable to have the procedure scheduled for first thing in the morning. There is less likelihood of delay getting started. Your doctor will also be fresh. 
    • Preferably do not schedule the procedure the day before a weekend or a holiday in case there are complications. Medical facilities tend to be understaffed on weekends and holidays.
  • Medications:
    • Review your List of Medicines with your doctor. Be sure it includes all prescription and over-the-counter drugs as well as vitamins, herbs and supplements.  Are there any drugs you should stop taking before the procedure? If so, which drugs, and how long ahead of time should you stop taking them?
    • NOTE: If there is a suggestion that you stop taking any drugs, even for a short period of time, check with the doctor who prescribed the drugs to find out what effect, if any, the time off will have. Also ask whether there are lifestyle changes or other drugs you should be taking during this period.
  • Find out what is necessary to prepare for the procedure. Preparation varies with the procedure to be performed. For example, a light meal may be recommended for the evening before, with no alcohol taken for a full day before surgery.  Generally, nothing is to be taken by mouth after midnight of the day preceding surgery - including food and water. (Eating or drinking can cause death under general anesthesia. A full stomach could lead to vomiting and subsequent aspiration of fluid into the lungs.) . 
  • Smokers should stop or cut back on smoking at least 72 hours prior to surgery. Longer is even better. Not smoking prior to surgery improves circulation and wound healing. It also improves the ability of hairlike projections in the lungs to remove mucus, which is important for the prevention of pneumonia after surgery.
  • Find out what would cause a postponement of the procedure.  For example, many procedures will be postponed if the patient has a cold, fever, chills or flu symptoms. Notify your doctor if such conditions exist. 
  • Line up a family member or friend to take you home. The doctor or facility won't let you leave after an outpatient procedure unless you are accompanied by an adult. Depending on the procedure, most patients are not fit to operate a motor vehicle after surgery. Find out whether the doctor or facility requires that the person arrives at the surgical location before the procedure with you as well. 
  • Speak with the doctor about pain management. Some doctors are not aggressive about pain management. As a general matter, people do not become addicted to pain medications when prescribed to manage pain from a procedure.
    • Try to get the prescriptions filled prior to the procedure. If you fill the prescriptions ahead of time, they will be waiting for you when you get home. 

What To Do And No Do On The Day Of Outpatient Surgery

DO

  • Make sure to follow restrictions about eating and drinking. A ban on drinking includes water. 
  • Bathe in the morning. 
  • Wear loose-fitting clothing 
  • Bring with you: 
    • Identification with a photograph. 
    • Your insurance information even if you gave it to the doctor before. o    
    • A check or cash to pay any co-pay or other payment as well as postoperative prescription drugs if you don't have them already. If you aren't sure how much you will owe, call ahead of time. You don't want to get to the procedure, only to find that it has to be postponed. 

DO NOT

  • Do not shave the area that is undergoing the surgery. Shaving can cause invisible abrasions/nicks that can allow germs to enter. If a surgical site needs to be shaved, the operating team will do it.
  • Don't chew gum prior to surgery. It can stimulate the secretion of juices that can interfere with your breathing during the procedure.
  • Do not wear make up anywhere near the area that will be operated on.     
  • Do not be late. 

If you will be unconscious during the procedure:     

  • Don't bring any more cash or credit cards than necessary. 
  • Do not wear jewelry. 
  • Remove dentures prior to the procedure. 

What To Expect If The Outpatient Surgery Will Be Performed In A Hospital

Most outpatient centers ask that the individual undergoing surgery arrive 1-2 hours before surgery to allow time for the following activities which usually occur in a preoperative waiting area:

  • Checking in.
  • Placing the IV that will be used in the surgery.
  • Administering medications such as antibiotics. (Antibiotics are started prior to surgery to prevent infection).
  • You may meet the anesthesiologist prior to the procedure. If so,he or she will review your medical information and discuss the anesthetic plan with you. The anesthesiologist can answer any questions or concerns at this time. 

You will then be escorted from the preoperative area to the operating room, which is usually chilly. The operating table (or bed) is well padded, but it is not nearly as comfortable as a bed at home.

  • Anesthesia monitors are placed on your body, including heart monitors on the chest, a blood pressure cuff on the arm to monitor blood pressure, and a soft rubber clip on the finger to monitor oxygen level. Extra oxygen is given by face mask or nasal tube while you are in the operating room.
  • The anesthesiologist begins sedating the patient and perhaps starts an additional IV line. Depending on the procedure, you may be given general anesthesia, local anesthesia, regional anesthesia, or spinal or epidural anesthesia.

After Outpatient Surgery

After surgery, you will be brought to a recovery room you will wake up if you were unconscious. Recovery can take from 1 hour to several hours. 

Ideally, you will wake up with minimal to no pain or discomfort. If significant pain is experienced, a nurse should be informed immediately. The recovery nurse monitors the patients and treats any problems that may arise, such as nausea, vomiting, chills, and low or high blood pressure. 

 All outpatient centers have strict discharge criteria. For example, it is likely you will have to meet the following criteria before being allowed to go home: 

  • Stable vital signs (heart rate, blood pressure, breathing rate, temperature, and pain level) 
  • Tolerate food and drink. 
  • Be able to empty your bladder. 
  • Walk without assistance. 
  • An adult is available to take the patient home. Most patients are restricted from driving for 24 hours after surgery. Patients often experience drowsiness and minor after-effects, such as muscle aches, sore throat, and occasional dizziness and headaches. Occasionally nausea may also be present. There may also be fatigue and discomfort for a day or two following the surgery. This discomfort varies depending on the type of surgical procedure performed. 

Before going home, find out:  

  • Who to contact if a problem occurs, including telephone numbers FOR 24/7
  • What medication to take for pain (including a prescription if you haven't already filled one) 
  • What to do to keep the wound clean 
  • What activities you can and cannot do - including when you can return to work and whether you need to restrict your work activities for a  period of time 
  • When you can start eating 
  • When to see the doctor for a follow-up if necessary. 

Once at home: 

  • Ideally, someone will stay with you for the first 24 hours to provide help when necessary and to call for help should a problem arise. 
  • The doctor should be alerted as soon as possible if a problem is suspected. The earlier the doctor is aware of a potential problem, the sooner appropriate treatment can be started to avert any long-term effects. 

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