Guest Editor: Pushing the Boundaries

As more complex surgeries become same-day cases, providers ask, ‘What else is safe to perform on an outpatient basis?’

As healthcare providers, we continuously push the boundaries of what we can safely do on an outpatient basis.

While this is the case for virtually every service line at ASCs and HOPDs across the country, it’s especially true in the GI space, where recent changes are allowing more patients to go home same day, and less invasive endoscopic procedures are largely replacing traditional, more invasive surgeries.

Many of the changes we are seeing today would have occurred eventually, but the global pandemic sped up the progression significantly. You had this dire situation where there were no beds available at overfilled hospitals for surgeries that were performed as inpatient-only cases.

Providers began asking the fundamental question — What is safe to perform on an outpatient basis? — with unprecedented urgency.

The answers, of course, varied greatly based on the types of procedures that needed to be performed — and providers’ comfort levels with those surgeries.

For bariatric cases, the answer to the safety question is clear. We have good data that these patients — patients who are meticulously selected — can safely be treated at accredited centers of excellence. Many facilities already perform same-day sleeve-gastrectomy procedures and other weight-loss surgeries, and obesity treatment is entering an era where patients no longer need “surgery” thanks to FDA approved devices that have been blessed by regulatory bodies.

Same-day colon surgeries are a different story. This trend began in Canada due to a critical need to perform COVID-cancelled cancer surgeries. Prior to the pandemic, nobody said, “You can do colon surgery, but it must be a day operation.”

The procedure sparked furious debates on social media, and while the science isn’t settled on the long-term safety and efficacy right now, some increasingly complex procedures were performed in an outpatient setting with positive results. Some centers are now transitioning to more complex same-day procedures by renting hotels nearby and providing nursing care for the recovery phase.

The innovation of providers combined with technology and technique improvements — trends we examine in detail in this Outpatient Surgery Magazine Special Edition — have resulted in an evolving landscape where traditional surgery is being replaced by endoscopy.

Just think about the evolution of a polypectomy — formerly an operation that involved an inpatient stay — something that has become a non-invasive, same-day procedure where polyps are removed by a surgeon with a colonoscope. The same is true of the treatment of swallowing disorders, as well.

The next phase of minimally invasive care will see endoscopic robotics allowing proceduralists to perform complex procedures with reduced training while achieving the same positive outcomes.

When I think of where we are headed, a quote from Samuel Shem’s (aka, Stephen Joseph Bergman) landmark medical novel “The House of God” jumps out: “The delivery of medical care is to do as much nothing as possible.”

This certainly rings true for the world of outpatient GI, does it not? After all, the goal is to perform a good surgery or procedure using the best technique in as minimally invasive a manner as possible — and then send the patient home as quickly as we can.

As we continue to reimagine what is possible in the world of same-day care and as minimally invasive endoscopy replaces traditional open surgery, it is the patients who ultimately stand to benefit most from this shift. OSM