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Ambulatory Laparoscopic Surgery
- 1. 30/03/2014, Gokak Dr M G Bhat Consultant Surgeon Minimal Access and Bariatric Surgery Nova Specialty Hospital, Koramangala Bangalore Medical Director Nova Medical Centers Pvt Ltd, India Greetings From…. Dr. M G Bhat MS, FRCS(England), FRCS ( Edinburgh), FICS DMLE (Law), DMIRCSEd (Informatics)
- 3. 30/03/2014, Gokak Dr M G Bhat 1. Of, relating to, or adapted for walking. 2. a. Capable of walking; not bedridden an ambulatory patient. b. Designed for or available to patients who are not bedridden: ambulatory care; ambulatory pediatrics.. am·bu·la·to·ry
- 4. 30/03/2014, Gokak Dr M G Bhat Ambulatory Surgery Office Surgery Patient Recovers from Surgery and fit to return home within few hrs Ambulatory Surgery Patient recovers from Surgery and fit to return home the same evening without overnight stay The Day Care Surgery Patient Recovers from Surgery and fit to return home within a day or 24 hrs Short Stay Surgery Upto 72hrs
- 5. 30/03/2014, Gokak Dr M G Bhat Changes Brought in by Minimal Access Surgery • Change in the Entire Concept of Recovery • Fast Tracking of Surgery • Early Recovery and Discharge • No NG Tubes • No Drains • Early Feeding • Early Mobilization 1973 1976 1991 2000
- 6. 30/03/2014, Gokak Dr M G Bhat Short Stay Surgery 72hrs Stay •Comfort Level & Flexibility •Bariatric Surgery •Spine Surgery •Knee Replacements •Bigger Surgeries in Fit Patients •70% of all Surgeries
- 7. 30/03/2014, Gokak Dr M G Bhat Concept :… Early Discharge • Mobilse Early • Feed Early • Control Pain • Safety & Quality In 2008: 20% of the surgeries were day care in India. In J Med Sci. 2008;3(3):101-116.
- 8. How to Discharge Early? 30/03/2014, Gokak Dr M G Bhat • Select a Good Patient • Select a Good Case • Select Good Infrastructure Hospital Good Risk Patient Avoid Complex Case Hospital with Good Support Elective Cases
- 9. Pre Operative 30/03/2014, Gokak Dr M G Bhat • Clinical Evaluation • Investigations • Assessment • Planning • Suitability • Motivating • Financials • Fix Date of Surgery
- 10. Operation – Surgery Day 30/03/2014, Gokak Dr M G Bhat • Admission in the morning (patient comes prepared) • Early Surgery ( No Waiting)
- 11. 30/03/2014, Gokak Dr M G Bhat GI: •Cholecystectomy •Appendicectomy •Hernia •Diagnostic •Gynecology •Bariatric •Colo Rectal •Others Others • General • Thoracic • Urology • Ortho • ENT • Interventional • etc MAS & Ambulatory Surgery
- 12. 30/03/2014, Gokak Dr M G Bhat Stand Alone Day Care Surgical Centers Part of a Multi Specialty Hospital Hospital Only Few in India • Good Infrastructure • 25-30 beds • 4 OR • HDU • Prepared to shift if required
- 13. 30/03/2014, Gokak Dr M G Bhat Procedure <12hr 24 24-48 72 Lap Chole 236 210 24 2 Ing Hernia 110 98 12 Inc Hernia 36 3 27 2 4 Sleeve Resection 41 39 2 Appendix 7 4 3 Diagnostic Lap 6 6 Colorectal 6 2 4 Fundoplication 4 4 Gastric 4 2 2 Hellers 2 2 Spleen 1 1 Total 453 321 74 46 12 Personal Series: Lap in Nova Specialty Hospitals: 2010-13
- 14. * Clinical outcomes Metric Same day discharge ~60% Superficial Post- Surgical Infections 0.035% Transfer to Other Hospital (for observation) 0.12% (31 nos.) Fatalities* 0.01% (3 nos.) Clinical outcomes Urology, 1598, 5% ENT, 4349, 14% General Surgery, 11280, 37%Gynaecology, 4039, 13% Opthomology, 1739, 6% Orthopedics, 5100, 17% Plastic surgery, 1233, 4% Same day discharge (<24 Hrs) 24-48 Hrs discharge Beyond48 Hrs discharge 15% 25% 60% Nova Audit : 2009-2013 : >30,000 Surgeries
- 15. Technical Consideration 30/03/2014, Gokak Dr M G Bhat • Preop Motivation and Planning • Anesthesia ( Quick Recovery) • Analgesia • No Sedation • PONV (Post op nausea and vomiting) • Early Ambulation • Early Feeds • Passing Urine • Encouragement • If all OK Discharge
- 16. 30/03/2014, Gokak Dr M G Bhat Technical Consideration Sensorcaine Infiltration into wound Instillation in Peritoneum Abdominal Support in Incisional Hernias
- 17. Financials 30/03/2014, Gokak Dr M G Bhat 1. Package Rate Uniformity Transparent 2. Professional Fee 3. Insurance Acceptance
- 18. Advantage: 30/03/2014, Gokak Dr M G Bhat Early Discharge Recovery at Home Return to work Ease and Convenient Cost Saving Less of INFECTION Surgeons Comfort
- 19. Disadvantage 30/03/2014, Gokak Dr M G Bhat Surgeon Mindset Acceptance Complications General Specific to surgery Need for Shifting to Tertiary Care? Return to center
- 20. 30/03/2014, Gokak Dr M G Bhat Consultant Surgeon Nova Specialty Surgery Hospital, Bangalore Medical Director, Nova Medical Centers Ltd, India Thank you Dr. M G Bhat MS, FRCS(England & Edinburgh), FICS, DMLE (Law), DMIRCSEd (Informatics)