Case Scenario – Outpatient Surgery?
Description
Technology and reimbursement patterns have increased the amount of
surgery performed on an ambulatory basis. Hospitals all over the
country are experiencing a rise in the number of surgical patients who
come into the hospital and go home on the same day; cases that
previously required at least an overnight stay in the hospital. The
move to outpatient treatment can significantly affect a hospital’s use
of beds and its overall organization. However, the move to outpatient
care also poses some risks, especially to patients with difficult
medical histories. The move from inpatient to outpatient care is driven
by cost containment, as well as by new technologies. However, there
are risks to care provided in the ambulatory setting. For example,
advanced age (especially older than 70 years) is associated with
increased hospital stay and perioperative morbidity and mortality.
Additionally, the type of surgery is important in the risk assessment.
In the following three case scenarios, determine if the patient has
an increased risk for surgical complications based on their current
health status and medical history. Write a 1-2 paragraph response for
each scenario, and determine the following:
- Does the patient’s medical history pose a potential risk for
complications prior/post surgery? Explain your reasoning. - Based on the patient’s current health status and their
medical history, should they receive surgery or be evaluated and
treated outside of the ambulatory care setting? Explain your
reasoning.
Case Scenario 1:
|
Mr. Rogers is a 51-year old male. During his pre-operative |
Case Scenario 2:
|
Mr. Sanders is a 61-year old male who presents with nausea |
Case Scenario 3:
Mrs. Miller is an 88-year old woman who presents with
nausea, vomiting, and severe abdominal pain. Further tests reveal that
her white blood cell count is 13,000/mm3. Her physical examination
reveals that her abdomen is distended and very tender to the touch.
Her doctor suspects that she has acute pancreatitis. Mrs. Miller has a
preexisting medical condition of heart failure and gastroesophageal
reflux disease (GERD). She is also scheduled for outpatient surgery
on her thyroid.
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