Outpatient anesthesia, also referred to as ambulatory anesthesia, has gained traction in the past few decades as a safer and more cost-effective method of anesthesia for specific surgical procedures. It refers to the use of anesthesia during surgical procedures where the patient does not stay at a hospital overnight and can be discharged on the same day of the procedure. Outpatient surgery allows patients to reduce their medical costs and, in many cases, experience a speedier recovery. The increase in the use of outpatient anesthesia and surgery can be attributed to developments in anesthesia medications and techniques through history, technological advancements in medicine, and advocacy from patients and medical professionals.
The history of outpatient anesthesia and surgery begins with the history of anesthesia itself. Although surgical procedures have been around for centuries, it wasn’t until the 19th century that anesthesia began to be used during operations (5). Crawford Long, William Morton, and Horace Wells were some of the first clinicians to demonstrate the use of anesthesia in the 1840s (4). Long discovered ether anesthesia in 1842, but his discovery went largely unnoticed until William Morton demonstrated its use at the Massachusetts General Hospital in Boston four years later (5). Horace Wells was one of the first clinicians to use laughing gas as an anesthetic drug in 1844 (4). After the success of Morton’s demonstration, Wells experimented with ether, chloroform, nitrous oxide, and other chemicals to test their anesthetic properties.
The popularization of the use of anesthesia and the corresponding increase in surgical procedures created a medical system that was more dependent on hospitals and raised the cost of medical care worldwide (5). As a result, another generation of physicians began to experiment with outpatient anesthesia at the turn of the century. A British surgeon named James Nicoli documented the successful use of ambulatory anesthetics in nearly 9,000 surgical cases involving children in England between 1899 to 1908 (4). Ralph Waters, an American physician, established a downtown anesthesia clinic in Sioux City, Iowa in 1919 where he performed minor operations independent of a hospital (2). In fact, Waters’ “Down Town Anesthesia Clinic” largely resembled present-day ambulatory surgery centers.
After these advances in outpatient anesthesia relatively early in the field’s history, new developments in outpatient surgery and anesthesia remained infrequent for the next few decades. Hospital-based general anesthesia and inpatient surgery were the norms until the latter half of the 20th century. Hospital-based outpatient surgeries were first performed in the 60s at Providence Hospital, George Washington University, and the University of California, Los Angeles (5). Finally, outpatient surgery began to gain popularity in the 1970s as advances in anesthesia and surgical techniques made it possible to perform more complex procedures in an outpatient setting (5). By 1990, more than half of all surgical operations performed in America each year were outpatient surgeries (5).
Outpatient surgery offers a number of advantages over traditional inpatient surgery. Patients are able to return home the same day as their procedure, which means they can avoid the inconvenience and expense of a hospital stay. Additionally, outpatient surgery is often less expensive than inpatient surgery and allows for a faster recovery time (5).
Some hospital trustees and insurance companies opposed outpatient surgery in its early stages due to the potential for a reduction in hospital revenue and increased risk. Luckily, changes in insurance policies have shifted to supporting outpatient anesthesia and surgery over time (5). Evolving medical technology and patient advocacy by physicians continue to refine the practice of outpatient anesthesia and surgery in the present day to make it safer and more regulated.
References
- Committee on Ambulatory Surgical Care, “Guidelines for Ambulatory Anesthesia and Surgery.” American Society of Anesthesiologists, 17 Oct 2018, www.asahq.org/standards-and-guidelines/guidelines-for-ambulatory-anesthesia-and-surgery
- Hedley-Whyte, J and DR Milamed. “The evolution of sites of surgery,” Ulster Medical Journal, Jan 2006, vol. 75, no. 1, pp 46-53.
- Pandit, Sujit K. “Ambulatory anesthesia and surgery in America: A historical background and recent innovations.” Journal of PeriAnesthesia Nursing, Oct 1999, vol. 15, no. 5, pp. 270-274. doi: 10.1016/S1089-9472(99)80033-1
- Pregler, Johnathan L and Patricia A Kapur. “The development of ambulatory anesthesia and future challenges.” Anesthesiology Clinics of North America, Jun 2003, vol. 21, no. 2, pp. 207-28. doi: 10.1016/s0889-8537(02)00073-1.
- Urman, Richard D. and Sukumar P. Desai. “History of anesthesia for ambulatory surgery.” Ambulatory Anesthesia, Dec 2012, vol. 25, no. 6, pp. 641-647. doi: 10.1097/ACO.0b013e3283593100
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