One-stop surgery: Evolving approach to pediatric outpatient surgery

Purpose: Maximizing patient satisfaction is of prime importance in today's competitive outpatient surgery market. The authors recently devised a syste m, one-stop surgery, which simplifies outpatient surgery for pediatric pati ents and their families by combining the traditionally separate preoperativ e evaluation and subsequent operation into one visit. This report describes our initial experience with one-stop surgery. Methods: Umbilical hernia repair, circumcision, and portacath removal were considered surgical procedures appropriate for our one-stop surgery pilot s tudy. Medical information obtained by phone or fax from referring physician s was used to identify potential candidates. Families were contacted, prece rtified for their surgical procedure, and given nothing by mouth instructio ns. The day of surgery the child was evaluated by the attending pediatric s urgeon. If the diagnosis was confirmed, and no contraindications to surgery were identified, the child immediately underwent the prescheduled surgical procedure. Results: From April through October 1997, 61 children were scheduled for on e-stop surgery. Nine patients (15%) were no shows, and one additional famil y opted not to proceed with circumcision. The remaining 51 children (83%) u nderwent their one-stop surgical procedure: umbilical hernia repair (n = 23 ), circumcision (n = 19), portacath removal (n = 8), and inguinal hernia re pair(n = 1). No child had an anesthetic contraindication to surgery, and on ly one minor postoperative complication (wound hematoma) occurred. Conclusions: This pilot study has demonstrated that with appropriate patien t screening and cooperation of the entire surgical team, a variety of outpa tient surgical procedures can be handled using this one-stop surgery method . By combining one-stop surgery with our previously reported phone follow-u p system, many minor surgical procedures can be managed with only one visit to the hospital. Decreasing the "hassle factor" of outpatient surgery for children and their families, who frequently live far from their closest chi ldren's hospital, while providing the highest quality of specialized surgic al and anesthetic care, may potentially be a very powerful marketing tool f or pediatric surgical specialists. J Pediatr Surg 34: 129-132. Copyright (C ) 1999 by W.B. Saunders Company.