Surgical Complications

Comparing Surgical Complications between Inpatients & Outpatients



Comparing Surgical Complications between Inpatients & Outpatients

Introduction

More patients are being operated on in surgery settings, both in Sweden as well as in other countries. Economic benefits are expected because the patients do not need more than a few hours of hospital care. Nowadays surgery is performed using a highly developed technique. This has resulted in saving up to a quarter of the cost of routine inpatient (Ledet, 2000; Fleming et al., 2000). Decreased surgical trauma with the highly developed technique has a clear advantage over the conventional open technique with less pain, shorter hospital stay and faster return to normal daily activities and work (Beal & Dues, 2002; Keulemans et al., 2007; Willsher et al., 2007; Hollington et al., 2006).

Approximately 90% of all serious and critical patients operated on in surgery, can be discharged on the evening of the operation (Keulemans et al., 2007; Willsher et al., 2007; Bringman et al., 2001). All patients are not suitable for surgery but, with well-formulated inclusion and exclusion criteria and preoperative information, this form of surgery is both safe and effective (Hession, 2007). Patient selection in accordance with the American Society of Anaesthesiologists (ASA) is to determine whether or not patients operated on in surgery are well established in the assessment of the patient's medical status (Singleton et al., 2006).

Morbidity and mortality rates for highly developed serious and critical patients are reported to be low and between 0 and 1% of patients are reported to experience complications (Gadacz & Talamini, 2001; Huang et al., 2007; Young & O'Connell, 2001). Although major surgical complications following LC are uncommon, it is important to investigate patients' postoperative recovery. Young & O'Connell (2001) explored patients' recovery following LC in an 8-hour stay facility. Problems with mobility, pain and elimination recorded the highest mean scores. In addition, other authors have reported on postoperative pain following LC. Fleming et al. (2000), for example, reported that two-thirds of their patients experienced mild to moderate pain on the day of surgery, and Cason et al. (2006) reported that 85% of their patients experienced pain on day 1. Pain ratings declined gradually but on day 7, half of the patients still experienced pain.

In a randomized controlled trial, Hollington et al. (2006) investigated the need for postoperative analgesic in patients who underwent surgery vs. those who were hospitalized. They reported a 24.4% rate of narcotic use in patients who stayed at least one night in hospital, compared with none in the inpatient group suggesting that narcotic analgesic use may be related to the availability and ward practice and not the patients' need. Alternatively, Keulemans et al. (2007) found no differences between a surgery and inpatient groups concerning intake of pain medication during the first 48 hours.

Other commonly occurring complications described following LC are nausea and vomiting (Cason et al., 2006; Singleton et al., 2006; Fleming et al., 2000; Young & O'Connell 2001). Cason et al. (2006) reported that 17% of their patients had nausea persisting ...