W
hen Harbinder S. Chadha, MD, started his career
in 1998, orthopedic surgery was mostly a hospital-
based affair. Back then, a hip-arthroplasty patient
would be admitted the night before the surgery,
and then recuperate in the hospital for 5 to 14
days afterward. It was pretty much the same for an ACL repair.
My, how times have changed. Today, Dr. Chadha does about 150
total joint replacements per year. Patients arrive in the morning, have
the surgery and, barring any complications, are back at home in their
own beds later the same day.
Total joints are just one example of procedures that were once
"inpatient only" but are now being done routinely in outpatient set-
tings. He sees this steady migration as a classic example of providers
simply giving consumers what they want.
"Patients have been driving this," says Dr. Chadha, who practices at
the Otay Lakes Surgery Center in San Diego, Calif. "They wanted their
independence in controlling their pain medication, they wanted their
autonomy and they wanted their privacy. They knew they could gain
all those by having us get them home quicker."
For David Shapiro, MD, a Tallahassee, Fla.-based anesthesiologist
and past president of the Ambulatory Surgery Center Association, the
procedures now being performed in outpatient facilities were
"unimaginable" 20 or even 10 years ago. He credits seismic shifts in 3
distinct areas: less invasive approaches to surgery; more effective
assessments of patients and their home-care situations; and advances
in pain management.
"Patients have come to expect 100% perfection from their surgery, no
matter where it's being performed," he says. "The care in outpatient
facilities tends to be equal to inpatient or even better. We've also seen
the rapid deployment of new drugs that are more potent, with a faster
M a y 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 3 7
