Post-operation complications, especially those that result in having the discharged patient readmitted to a hospital or health system emergency room, significantly impact a surgical center’s record, reputation, and overall effectiveness. Taking steps to drive down post-op readmittance is essential. Modern surgical centers and clinics have invested much time and money.
While much of the effort has been rightly focused on monitoring and managing discharged post-op patients’ recovery, the right investment of time and resources to prepare patients before the surgical procedure can also pay dividends for surgical teams.
Recent Trends in Surgery
The past three decades have witnessed a nearly exponential trend toward less invasive operations within the surgical field, primarily in an outpatient setting.
From general surgical procedures to those of subspecialties, surgical techniques and industry-driven improvements in technology have allowed healthcare providers to achieve superior post-operative results through smaller incisions and little-to-no time spent in the hospital. From a patient perspective, this allows a post-operative recovery within the familiar comfort of their own homes.
Over time, the objective growth of outpatient surgical procedures in hospitals’ total surgical volume has been measured, increasing from 50% to 67% between 1994 and 2016, with an additional anticipated 15% growth by 2028.
Focus on the Quality of Care Continuum for Perioperative Care
In today’s emerging healthcare climate, where patient care quality has taken precedence over quantity, the advantages of outpatient surgical procedures are clear for the patient, surgeon, insurers, and hospitals alike. The challenge in this transition to more outpatient surgery is to ensure that inpatient care’s baseline quality must not be sacrificed or diminished when transitioning to the outpatient setting.
In other words, patients can expect the best care when they’re still in the hospital, ambulatory surgical center (ASC), or clinic because they’re surrounded by trained professionals equipped with the best available tools. How do they receive the same quality of care while they recover from home after having been discharged?
While there are various mediums to ensure the maintenance of healthcare quality, merging digital technology to streamline and simplify the indirect patient-surgeon interface is a promising field.
To modernize this approach, digital health companies have been developing and introducing enriched, mobile digital platforms designed to provide improved patient satisfaction, reduce emergency visits, increase overall patient engagement, and decrease perioperative call volume.
The Importance of Educating Pre-op Patients of Possible Post-op Issues
In the minds of most patients, they may not know what to expect from the procedure they’re about to have. Experienced surgical teams have a strong understanding of their point of view. But patients often start with a nearly blank slate and almost no knowledge of what to expect.
This disconnect between what surgery teams know to expect and what patients understand is a key source for many post-op issues, complaints, and complications. Dealing with this disconnect before the surgery (and post-op and post-discharge) may not prepare patients for what’s about to happen. The right pre-op guidance and post-op communication help patients better understand what their bodies are going through after the procedure.
For example, comorbidity (such as cardiac or respiratory condition) and risk factor associations (including age and BMI) with expected medical and surgical complication rates allow physicians to modify preoperative variables and appropriately counsel patients – to optimize postoperative outcomes. But do patients understand how these same comorbidity and risk factor associations impact their recovery?
When patients are genuinely aware of the anticipated risks associated with a particular procedure and the unanticipated complications that could arise, patients can react with less anxiety when these problematic but not unexpected events occur.
Educating patients before the surgical procedure can also decrease the likelihood of unnecessary emergency calls and readmittance. Seeking emergency health services in response, therefore reducing overall readmittance.
Additionally, understanding patient and physician perceptions regarding the occurrence and severity of complications is crucial for counseling patients on expected outcomes and complication rates.
Although surgeons and patients agree on the presence of complications, there is discordance between inpatient and surgeon perception of complication severity.
For example, a cohort of 229 spine surgeons and 197 patients were surveyed regarding the presence or absence of a complication in the context of 11 hypothetical scenarios. There was a consistent agreement between surgeons and patients on the presence of complications; however, a notable variation arose between the cohorts when asked to rank the severity of complications. Patients were consistently more critical and ranked complications as more severe.
In other words, patients in postoperative care are more sensitive to the after-effects of their procedure than physicians and surgeons – and are more likely to consider those issues as serious complications.
Therefore, given an inherent bias to under-reporting complications and severity by physicians/surgeons, it would be advantageous to ensure consistent and clear communication from the surgeon to the patient.
The Changing Demographics of Surgery Patients
Over the last ten years, there has been a relatively stable patient mortality rate at approximately 1%; however, increasing average patient age at surgery and associated increases in patient comorbidities have led to an overall increase in the risk of postoperative patient complications. Therefore, the average surgical patient from year to year becomes slightly older and slightly more of medical liability.
As the political climate of medicine remains uncertain and healthcare expenditures, for better or worse, are being constrained and allocated strictly based on both subjective and objective quality, the ability to decrease postoperative extraneous expenses is paramount. By increasing patient engagement through a refined and responsive digital platform, perioperative care management platforms and solutions can promote relevant education and practical patient guidance.
Limiting potential confusion from a surgical preparation standpoint by standardizing and communicating instructions streamlines the overall experience, thus reducing anxiety for the healthcare team, and most importantly, the patient. Consistent monitoring and effective post-discharge care management can decrease emergency visits and perioperative call volume, likely secondary to their platform that facilitates increased patient engagement.
Whether performing an outpatient minimally invasive lumbar interbody spine fusion or bilateral cataract surgery through an ambulatory surgery center, understanding the generalized risks associated with the preoperative and intraoperative variables allows both modifications of risks and proper adjustment of patient expectations.
To properly evaluate the impact of preoperative guidance on lowering postoperative complications and readmittance, understanding what actually constitutes a complication is necessary. Despite the differences in inpatient and surgeon perceptions of complication severity, studies have also suggested that patients and surgeons can agree on complication severity when complications are correctly classified.
For example, agreement on complication severity was reached between patients and surgeons in roughly 2/3 (64%) of scenarios when complications were classified on a binary scale. After further assessment of the scenarios, definitions of major (severe medical complications or need for additional surgery) and minor (transient events without permanent sequelae) complications were generated.
Most notably, four of the scenarios featured purely medical adverse events, with no direct relation to the relevant surgery described. Both surgeons and patients definitively reported that a complication had occurred, which argues for the inclusion of adverse medical events within perioperative complications.
While direct surgical variables after often difficult to modify, given the inherent necessity and complexity of the particular procedure, many medical comorbidities have the potential for preoperative optimization. There are many well-known risk factors for postoperative complications, including advanced age, alcohol use, tobacco use, obesity, and medical comorbidities such as cardiac, pulmonary, and renal disease.
In certain subspecialties, the male gender has also been cited as an independent risk factor for surgical morbidity. Looking at spine patients in particular, when stratified by incremental age blocks, a significant increase in complications with each advancing age block was demonstrated, which anecdotally is likely sustained throughout most surgical subspecialties.
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Despite increased risks of complications among the elderly spine patients, studies have also demonstrated notable clinical improvement with operative management in the elderly population. This is further reflected by increased national rates of surgical intervention in elderly patients and decreased rates of postoperative complications among elderly patients, perhaps due to increased awareness and emphasis on preoperative optimization of complication risk factors.
Another demographic factor the health care system has seen over the past decade is the increased acceptance of digital tools, apps, and platforms by consumers. In fact, many patients have come to the point that they wonder why healthcare providers, including ASCs and surgery centers, “don’t have an app for that”!
Tracking Vitals and Symptoms Digitally to Head Off Complications
The ability to track vitals and symptoms through a digital interface, connect healthcare-related applications, and integrate medical records and health data has notable benefits for both consumers and businesses.
From a consumer standpoint – a proven reduction in acute care utilization results in easier to manage patients with better outcomes, reduced healthcare expenditure, and improved patient satisfaction. From a business standpoint – a reduction in hospital readmissions increases revenue by streamlining and simplifying clinical medical care and decreased the rate of costly medical errors.
Overall, the footprint of outpatient surgical intervention is growing, complications are unavoidable, the field of medicine continues to evolve and increase in complexity, and patients will always need physicians. It is undeniable that preoperative guidance for an outpatient surgical procedure, both from a preparation standpoint and understanding of inherent rehabilitation/restrictions/potential complications, is beneficial.
At the end of the day, medical technology should form a synergistic relationship with healthcare treatment, and the right tools and resources can facilitate the stability of this relationship.