Feature

High-Speed Surgery

These days, a visit to the hospital for surgery may be over more quickly than the drive there, as surgeons begin to utilise fast, efficient operating methods.

By Cathryn Crane, NZSM

Surgical operations were once a cause for considerable anxiety and domestic disruption, but many patients now have the option of day surgery. Advances in medical techniques and drugs means that an increasing number of common operations can be over and done with in less than a day. Patients are able to come in, have their operation and go home again.

Day surgery has benefited from developments in anaesthetics, with shorter-acting drugs enabling faster patient recovery. Electronic developments have resulted in high-quality monitoring systems and surgical assistance.

Dr John Coughlan, manager of surgery for the Canterbury Area Health Board, sees day surgery as a major advance, both in terms of patient welfare and in freeing up much-needed financial resources.

Financial Incentives

Financial benefits have been at the heart of much of the impetus behind the development of day surgery overseas, Coughlan admits. Insurance companies in the United States often will not pay for operations on an in-patient basis when the option of day surgery exists. Coughlan sees the same thing happening here.

"Financial incentives are being placed in New Zealand to make day surgery happen," he observes. Hospitals are able to save on the whole range of hotel-like services and facilities for overnight patients, and concentrate on medicine. In times of shrinking health budgets, such savings can be significant.

Coughlan is quick to point out that cost savings are only one advantage. He sees the real benefits lying in patient well-being. Day surgery puts far less stress on patients and their families, particularly where children are concerned.

Better For Children

Ear, nose and throat surgery is one area that has benefited from day surgery techniques. Children being treated for glue-ear or tonsillitis can be operated on and home again by evening. What can be a traumatic stay in unfamiliar surroundings is no longer necessary. Parents don't need to find babysitters or rearrange domestic schedules to stay with a hospitalised child.

Coughlan sees little point in keeping a child in a hospital environment when they could be cared for equally well at home.

"If you've had your tonsils out, your throat will hurt, but you're going to have a sore throat whether you're in hospital or at home," he notes. "At least at home you're in familiar surroundings."

The important thing is patient education -- explaining to patients and their care-givers what the surgery and the recovery involve. Surgeons are careful to select those patients who are most suitable for day surgery. The selection involves everything from assessing the health of a patient to looking at their family situation. The latter is important to ensure that there is adequate provision for caring during the limited recovery period.

At the pre-admission stage, the procedures and follow-up practices are explained so that the patient understands what is being done.

Maintaining Quality

"The key thing is the quality of care is no different," says Coughlan. "It's the before and after that is different."

Coughlan has seen the system operating effectively. In Timaru, over the four-day New Year break, 35 patients were treated for cataracts in a day surgery blitz. One of the patients was Coughlan's mother. She, and the others who were operated on, were happy to have their eyes treated under such a system.

"We needed to do something about the waiting list, and theatre time was available over New Year," notes Coughlan.

Coughlan stresses that day surgery isn't the answer to all problems, and that day surgery units must always have the backup of full medical facilities. In Christchurch, Princess Margaret Hospital is developing a day surgery centre that will be able to offer a range of operations, but still have full facilities available.

"You need very high quality techniques because the patient is going home. You've got to be painstakingly careful," Coughlan maintains.

Quick Recovery

One of the high quality techniques recently introduced to New Zealand is in gallbladder surgery. Surgeons at Christchurch Hospital were given the opportunity to learn a fast, effective means of extracting gallbladders from patients. The conventional operation requires a hospital stay of a week, with recovery time at home of as much as six weeks. It involves major abdominal surgery, producing considerable pain and scars.

Four years ago, a new technique -- laparoscopic cholecystectomy -- was developed. This involved using an optical instrument teamed with video cameras to observe the excision and removal of the gallbladder through a small skin incision. The patient can go home the same day or the following day, and can return to work within a week.

One of the major advantages of the technique is that local anaesthetics are used to numb the incision area, keeping pain to a minimum. This reduces the chance of a pain/medication cycle being established, Coughlan notes.

Such a cycle can be a real problem, with patients becoming dependent upon pain relief. If they are able to wake up after an operation and feel no pain, then they are far less likely to require medication and will have an easier recovery period. The less invasive approach also means less nausea, as the abdominal organs are barely disturbed.

Christchurch doctors attending a seminar on the technique were stunned to see a patient who had been operated on the same day attend the meeting feeling fine. Such a quick recovery was in stark contrast to the normal lengthy convalescence following removal of the gallbladder.

Day surgery techniques can be used for a whole range of operations, including operating on hernias and varicose veins, as well as excising breast lumps and correcting squints. If these operations can be done just as well, but more quickly and more cost-effectively, then everyone will benefit.

Cathryn Crane is a freelance journalist with an interest in environmental issues.