What is an Inpatient Surgery?

Inpatient surgery refers to any surgical procedure after which a patient needs to remain in hospital overnight or longer. The length of stay depends on the patient’s health status and the type of procedure performed.

While there is a clear tendency to move several minimally invasive surgeries in outpatient settings, like hospital outpatient departments (HOPDs) or in independent ambulatory surgery centers (ASCs), approximately half of procedures in the U.S still take place in inpatient settings.

In the article below we will review the most common inpatient surgery types and key differences between in and outpatient approaches.

Differences between out and inpatient surgeries

Typical candidate – in our article about outpatient surgery we have stated that an ideal candidate for outpatient surgery is otherwise healthy people, who need minimally invasive procedures. In the case of inpatient surgeries, things are vice versa.

Either the surgical procedure itself is invasive, involves large incisions and careful surveillance afterward, or the patients have comorbidities like heart and lung diseases, tumors, etc.

Age itself is not a primary defining factor in choosing between in and outpatient treatment, but it should be taken into account that the action of anesthesia in the elderly is often prolonged.

As a result, it will take longer to recover after even minor procedures with general anesthesia, hence day-surgery might not be suitable for such patients.

Convenience – While some surgeries take place exclusively in hospitals or ASCs, for other procedures patients might have a choice between in and outpatient settings.

Recovering at home in a less stressful environment and family members’ attention seems to be a better option, and in some cases it is. But no support from hospital staff is available and in case of necessity, it will take longer to seek expert medical help.

There is always a chance for outpatient surgery to become inpatient due to post-operational complications.

Costs

Numerous factors determine the cost of procedures, and this statement will not always coincide with reality, but in general, inpatient care is more expensive because there are more costs associated with an overnight stay.

The 2017 study has compared the costs of outpatient versus inpatient Unicompartmental Knee Arthroplasty (UKA). According to results, outpatient UKA charges were about $20,000 less than the average costs of the same procedure conducted in inpatient settings.

The difference was mainly attributed to facility charges, with hospital fees being 350% more expensive.

Facility charges were $3,800 on average for outpatient UKA and $13,200 for hospital patients. We should also mention that there was no difference between those two groups in terms of complications and readmission.

The most common inpatient surgeries

According to the Agency for Healthcare Research and Quality, in 2018 9.6 million inpatient stays involved OR procedures. Stays involving OR procedures totaled $210.3 billion in aggregate costs. Here is the list of top procedures in 2018 U.S. National Inpatient Stays

1) Knee arthroplasty – also known as knee replacement surgery, with more than 715,000 stays leading the list. The procedure helps to relieve pain and regain the function of damaged knee joints

2) Hip arthroplasty – The most common indication for this procedure is severe osteoarthritis. Around 600,000 hip replacements were performed in 2018

3) Percutaneous coronary interventions (PCI) – even though this minimally invasive procedure is not qualified as surgery, in most cases it still requires an overnight hospital stay. About half a million procedures are performed annually.

4) Spine fusion – patients with a herniated disk, deformities of the spine, spinal weakness, or instability benefit from this surgery. 455,000 procedures in 2018

5) Cholecystectomy – roughly half of the gallbladder removal surgeries are performed in hospital settings. 330,000 procedures in 2018

6) Femur fixation – 307,000 procedures in 2018

7) Colectomy – various conditions require removal of a colon portion, including diverticulitis, cancers, inflammatory diseases. 297,000 procedures in 2018

8) Vertebral discectomy – 285,000 procedures in 2018

9) Subcutaneous tissue and fascia excision – 239,000 procedures in 2018

10) Bone excision – 227,000 procedures in 2018

We can also compare the proportion of ambulatory and inpatient surgeries by body system. Procedures conducted on obstetrical, cardiovascular and pulmonary systems seem to involve mostly inpatient care. On the other end are the systems that are least dependent on hospital care: eye, ear, nose/mouth/pharynx.

Preparations for inpatient surgery

The preparation depends on diagnosis and surgery type. According to these factors, doctors will conduct different tests. But in general, people who will undergo anesthesia are asked to:

  • Not to drink or eat for some time before surgery
  • Undergo routine tests like ECG, blood tests, x-ray, etc
  • Not to wear jewelry, makeup, eye lenses, dentures, prosthetic devices and leave valuables at home
  • Bring comfortable clothes and essentials

Summary

Inpatient surgeries are the mainstay of treatment of numerous conditions. This form of medical care requires at least one overnight stay. In some cases, patients can choose between inpatient and outpatient settings.

References: 

https://www.ncbi.nlm.nih.gov/books/NBK442035/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2552979/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400228/
https://www.hcup-us.ahrq.gov/faststats/
https://www.hcup-us.ahrq.gov/reports/statbriefs/
https://stanfordhealthcare.org/medical-treatments/

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