THE SAME DAY: TECHNOLOGICAL ADVANCEMENTS BOLSTER THE POPULARITY OF UNIT

Same-day surgery is said to owe its popularity in large part to technology. It's that technology that has made the removal of kidney stones less of a pain today.

In the past, treatment for kidney stones at St. Francis Medical Center in Cape Girardeau required hospitalization, said Dottie Worley, the hospital's director of surgery. But Worley said the procedure became a same-day surgery procedure or outpatient practice probably within the past year.

Now, Worley said, shock waves from a type of device that looks somewhat like "a big spark plug" are used to break up the stone, and the patient is able to pass it.

Worley said she believes technology is a big factor in the popularity of same-day surgery.

"It's like examining the knee. We're able to go into that without opening the knee up. We can go in with scopes and correct the problem."

Along with kidney and knee procedures, same-day surgery is also used for hernias, cataracts, tonsils, adnoids, breast biopsies, and urology complications, medical officials say. Plastic surgery even falls within its realm.

Same-day surgery appears popular enough at St. Francis. Last year the hospital saw 4,836 patients for same-day surgery procedures, Worley said.

Within the last two years, she said, a slight increase in same-day surgery has occurred at the hospital. The real increase, she said, took place from 1989 to 1990.

"I would say that 60 percent of my schedule is outpatient." In 1989, Worley said, the procedures accounted for around 50 percent of her schedule.

Worley said the same-day surgery procedures are done in the hospital's 10 major operating rooms. The hospital also has two rooms for urology procedures, she said.

Worley also attributed the popularity of same-day surgery to being able to start a person out as an outpatient. If after evaluation more surgery is needed, she said, the patient is converted to an inpatient.

Lois Scott, director of the surgery department at Southeast Missouri Hospital in Cape Girardeau, said same-day surgery has primarily increased in use because of Medicare and private insurance companies, which are looking for ways to keep down costs.

"In other words," she said, "they don't want to pay out any more money than necessary." One way to do that, she said, is to have the whole process done in a 24-hour period.

In 1982, Scott said, the percentage of outpatients at Southeast was 9 percent. Here, almost 10 years later, that has jumped to 61 percent, she said.

In 1991, the hospital's total surgery count was about 6,400, of which about 3,800 would have been done on an outpatient basis, said Scott.

Scott said a lot of big hospitals have a free-standing facility for same-day surgery, or one that is run on a somewhat separate basis. But Southeast does its outpatient surgery in the same building as inpatient surgery.

"All of ours is done in the same facility and the same operating suite. The same level of care is given to both inpatients and outpatients," she said.

Since Doctors' Park Surgery opened in December 1976, approximately 15,000 same-day procedures have been done there, said Administrator Ron Wittmer. The most common same-day procedures involve ear, nose and throat complications and general, gynecological, plastic, and oral surgeries.

The 10,000-square-feet Doctors' Park Surgery building is at No. 30 Doctors' Park. Wittmer said healthy, rather than sick patients, are operated on at the facility.

Same-day surgery is growing in use because of "costs, privacy, and convenience," said Wittmer. "And mainly, with everyone talking about the high costs of health care, this is one way to keep that down."

In the mid-1970s, he said, medical experts estimated that about 40 percent of all surgical procedures could be done on an outpatient basis. That estimate is now up to 65 percent, he said.

"It looks like in the future sick people will go to the hospital (and) will be inpatients for surgery. Well patients will have it done on an outpatient basis," he said.

Scott says it's difficult to put an average cost on same-day surgery procedures. Different patients, she said, require different supplies. Plus, she said, the hospital tries to charge for what is actually used on each patient, rather than a general fee.

Wittmer also said Doctors' Park Surgery wouldn't want to quote an average cost.

"You don't know about the time, you don't know about what they're going to use," he said. "Averages are just that: averages," he said.

But Wittmer said at Doctors' Park Surgery, the same outpatient surgery procedure runs approximately one half the cost of outpatient surgery in a hospital.

Scott said a free-standing clinic is able to offer same-day surgery for less because their expenses are far less than at a hospital. However, in a hospital, she said, a patient has access to everything and doesn't has to be transferred in the event of an emergency.

Scott added that she wanted to correct a misconception that outpatient surgery can be done very quickly and that it doesn't amount to much.

"The term outpatient is misleading. It makes people think they'll be there an hour or two or three or four. And that may be the case, but in many situations it's an all-day" event, she said.