The Case for Performing Minimally Invasive Hysterectomies in Outpatient Settings
During an Oct. 25 session at the 20th Annual Ambulatory Surgery Centers Conference in Chicago, Jon Nielsen, MD, a surgeon with Maple Grove (Minn.) Ambulatory Surgery Center, made the case for performing laparoscopic hysterectomies in ASCs.
Many recently published studies show patient safety is not compromised by performing a laparoscopic hysterectomy in an ASC, said Dr. Nielsen. He has seen a decrease in overmedicated patients, and “we all know now that if we’re not admitted to the hospital, we’re less likely to get an infection,” he said.
To ensure patient safety, Dr. Nielsen stressed the importance of proper patient selection. ASCs should consider patients characteristics such as comorbidities, uterine size, previous abdominal surgeries and body mass index before clearing a patient for the procedure.
The ASC should also be fully prepared for unexpected complications, and have a transfer protocol to an inpatient facility. “You need to have a back-up plan,” said Dr. Nielsen. “The overarching concern has to be patient safety.”
Dr. Nielsen has also seen a high level of patient satisfaction following laparoscopic hysterectomies. “Patients are at least, if not more, satisfied than with hospital-based procedures,” he said. To obtain the highest level of patient satisfaction possible, he recommends ensuring patients and families are informed about the procedure, and have managed expectations.
Performing laparoscopic hysterectomies has also proven profitable for Dr. Nielsen’s ASC. His center has seen 40 to 50 percent margins on these procedures, far above the margin at a hospital. The length of surgery is also much shorter, allowing more procedures to be done per day. “If I can do five per day, how valuable is that?” said Dr. Nielsen.
“It really is a win-win-win, assuming you have qualified surgeons,” said Dr. Nielsen.
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