OUTPATIENT SURGERY: TECHNOLOGY HELPS SAVE PATIENTS FROM TIME IN HOSPITAL

Sherry Welter, right, a registered nurse, charted information for Glenn Love of Sikeston in the post-anesthesia care unit of St. Francis Medical Center. Love underwent outpatient orthopedic surgery.

There was a time when surgery meant spending days -- and sometimes weeks -- in the hospital recuperating.

Patients were admitted a day or two before the procedure for tests and screenings, had the surgery and rested and recovered for several days before heading home again.

Improvements in surgical technique and technology and the push for less expensive health care mean those days are long gone.

"Insurance trends have pushed a lot of procedures to be outpatient," said Dottie Worley, a registered nurse and director of surgical services at St. Francis Medical Center.

Outpatient surgery means the patient can go home the same day, saving the family, the employer and the insurance company thousands of dollars.

More than half of all surgical procedures performed at Southeast Missouri Hospital and St. Francis Medical Center are performed on an outpatient basis.

And Cape Girardeau has three ambulatory surgery centers where only outpatient procedures are performed: Doctors' Park Surgery Inc., Missouri Surgery Center and Cape Girardeau Outpatient Surgery Center.

"Procedures that were done in-hospital years ago can be done quicker and don't need the hospital stay," said Ron Wittmer, president of Doctors' Park Surgery.

Wittmer said it "makes no sense" for patients to be unnecessarily hospitalized.

Endoscopic technology -- miniaturized microscope-like instruments that can be inserted into the body through small incisions -- has been a major factor in the increase in outpatient surgery.

The technology means "we can visualize what we need to see without having to open up a body cavity," said Lois Scott, registered nurse and director of surgery at Southeast Missouri Hospital.

Smaller incisions mean quicker healing time, less risk of infection and less trauma for the patient, all of which add up to going home sooner. Patients can be held for 23 hours of observation and sent home without having to be admitted overnight.

"Everybody's clamoring for lower health costs," Scott said. "This is one way to be able to do it."

A wide variety of procedures can be performed on an outpatient basis.

Arthroscopic surgeries on joints, ear, nose and throat procedures, biopsies, carpal tunnel releases, laparoscopic gallbladder removals and tubal ligations, rhinoplasties, removal of tissue masses, tonsillectomies and a variety of orthopedic and diagnostic procedures can be performed on an outpatient basis.

"We're finding that we're doing more and more complicated cases on an outpatient basis," Scott said.

Some surgical procedures still require hospital stays, she said. Open-heart surgery, neurosurgery, total joint replacements, abdominal surgeries, many vascular procedures and hysterectomies all require hospitalization.

"Anytime you open up the body and do any major work inside, you're going to require a hospital stay," Scott said. "But that time's getting shorter and shorter all the time."

Most open-heart surgeries at Southeast are now done the day the patient is admitted, she said. Patients come in a day or two before surgery to have all their tests done.

"Then they arrive in the morning just before they're supposed to have their surgery," she said.

In some cases, surgery is no longer needed to correct a medical condition because new technology and medications can take care of it.

Extra corporeal shock wave lithotripsy, in which shock waves are used to dissolve kidney or gallbladder stones, is one example, Scott said.

"Kidney stones, you used to have to open up the body, and sometimes the kidney itself," she said. "That was major surgery."

The shock wave treatment "is one of the most wonderful developments," she said.

Worley said patients are also much more knowledgeable about the care they receive.

"They ask questions and they seek that information out," she said, adding patients also get better information about what will happen before, during and after their surgery.

"Also I think people are more interested in wellness now," she said, so patients tend to be healthier overall when they come in for surgery, which aids in quicker recovery.