“Outpatient procedures are the future”

Outpatient procedures have an image problem. Unfairly so, believes doctor Daniela Centazzo, director of outpatient surgical centres for the Hirslanden Group, because there’s no difference between outpatient and inpatient procedures in the operating theatre.

Text: Nicole Krättli; photo: iStock

With more and more operations being performed on an outpatient basis, the trend seems unstoppable. “This is due in part to ongoing technical medical progress, which makes it possible to perform many operations as standardised surgical procedures without impacting on the quality of the results,” explains Dr Daniela Centazzo, director of outpatient surgical centres for the Hirslanden Group. This development is driven, for example, by state-of-the-art anaesthetic procedures and gentler surgical techniques, which shorten the recovery time significantly. At the same time, more and more operations can be performed using minimally invasive techniques,which in turn leads to a much lower risk of complications.

Centazzo believes that this development benefits patients. It means that a procedure can be performed more quickly than before. The average length of stay for patients at the Hirslanden Group outpatient surgical centres is just two to six hours. Most patients are already back home by the evening and can recover from the operation in their own four walls instead of having to get used to the daily routine in a hospital.

It also means that patients are usually looked after by the same staff. “There’s usually no change in shift during an outpatient procedure. Patients are therefore usually admitted and discharged by the same person,” explains Centazzo. This not only makes the care more personal, but also has the advantage that the patient file doesn’t have to be handed over, which eliminates potential gaps in knowledge.

Ongoing shift from inpatient to outpatient care

In recent years, the motto of the Swiss healthcare policy has been “outpatient before inpatient” This is due in part to the increasing cost pressure on the healthcare system, which drives the need for lean processes and tailored workflows to ensure efficient, safe and cost-conscious healthcare.

As a result, January 2019 saw the introduction of six groups of procedures across Switzerland for which health insurance only covers the costs if they are performed on an outpatient basis. These include, for example, varicose vein surgery in the legs, haemorrhoid procedures, inguinal hernia surgery, examinations and procedures on the cervix or uterus, various minimally invasive procedures to treat meniscus injuries and surgery on the tonsils.

The second monitoring report 2020 published by the Swiss Health Observatory (Obsan) shows that the decline in inpatient procedures in 2020 was weaker than in the previous year, probably due to the pandemic. But there was still a noticeable shift from inpatient to outpatient care.

But there are exceptions. The “outpatient before inpatient” regulation allows for health insurers to pay for inpatient measures in justified cases. This could be the case, for example, with an existing illness or if the procedure takes place in combination with another operation that has to be performed as an inpatient procedure anyway.

According to the monitoring report, in 43% (for haemorrhoids) to 95% (for knee arthroscopies) of procedures performed as inpatient procedures in 2020, a reason for which the treatment was performed as inpatient can be identified. In 5 to 57% of exceptional inpatient procedures, no explanation could be found. According to the information, a small number of the exception criteria cannot be statistically recorded. However, the Federal Office of Public Health does not know whether this missing data can explain the entire difference.

Switzerland is playing catch-up with outpatient procedures

Although outpatient procedures are on the rise, they still have an image problem. And that is probably one of the reasons why Switzerland is lagging behind other countries when it comes to outpatient procedures. Around 30% of operations are performed as outpatient procedures in Switzerland compared to around 60% in the Nordic countries and around 80% in the USA. “We expect the situation in Switzerland to follow this trajectory,” says Dr Daniela Centazzo from the Hirslanden Group. And adds: “Outpatient procedures are the future. We don’t have a choice – we have to move with the times.”

The new system still tends to cause concern. Dr Centazzo is regularly asked by patients whether they receive the same standard of care for outpatient procedures as they do with inpatient care. “The moment the door to the operating theatre opens, there’s no difference between an outpatient and inpatient procedure,” says Centazzo, explaining that outpatient operating theatres are just as well equipped as inpatient ones, both in terms of staff and infrastructure. An outpatient operating centre is just as well equipped for emergencies as any hospital.

The only difference is the preparation and aftercare required for an operation. “If tests are requirements before an operation, these can usually be done with your family doctor,” says Centazzo. A structured aftercare concept is in place for the time after the operation, and this is explained to the patient in detail. “What’s more, patients can call an emergency hotline around the clock if they need assistance,” adds Centazzo.

But such emergencies are extremely rare. Centazzo explains that this is mainly because any operation that is performed as an outpatient procedure does not cause any relevant change in metabolism or organ function nor any significant blood loss. That’s why she is sure that outpatient surgery will become the norm for many harmless procedures – even in Switzerland. Centazzo says that the best feedback she gets from patients is when they say that they have never felt so comfortable in hospital before.