2003 Volume 42 Issue 2 Pages 138-145
Recently in the USA, Canada, Australia, UK, and some European countries, a trend towards performing surgical procedures on an outpatient basis has been prompted by political, financial and medical forces. In such countries, the majority of elective surgery is performed on an ambulatory basis. In contrast, the Japanese medical service system seems to be reluctant to approve day-case surgery. Here, we describe the present status of nasal ambulatory surgery in Japan by presenting the data obtained from a questionnaire.
Questionnaires were sent to 337 major hospitals in Japan that were qualified as training institutes by the Otolaryngologic Society of Japan. Answers were received from 248 hospitals. In 194 out of 248 hospitals (78%), some nasal surgery was performed on an outpatient basis. However, in most of the hospitals providing a positive response, only minimally invasive surgeries, such as cauterization of the inferior turbinates or polypotomies, were performed. Other, more invasive procedures were only performed on an outpatient basis in about one-fourth of the hospitals. The main reason why nasal surgery was not performed on an outpatient basis in the remaining 54 hospitals was the fear of complications.
Although day-case septoplasty and turbinectomies were only performed in 6 and 30 institutes, respectively, nearly half of the chief otolaryngologists in the hospitals that responded to the questionnaire thought that these operations were safe to perform on an outpatient basis, which means surgeons are ready when opportunity is ripe.
When asked about the factors that are essential for day surgery, the most frequent reply was “less bleeding”. Eighty two percent of the chief otolaryngologists in the hospitals that responded the survey believed that the number of outpatient surgical procedures would increase in the near future.
According to the DECD Health Data 2001, Japan has fewer physicians and far more beds than most OECD member countries. Japan also has a longer average hospital stay and more outpatient consultation days. These factors produce a too busy clinical scene that does not favor the popularization of day surgery. Fear of medical mishaps is another factor inhibiting the widespread use of outpatient surgery.
According to medical literature, the complication rate for septoplasty is around 10%, which is quite low. However, the unexpected admission rate after septoplasty is between 4 and 25%, which is greater than the acceptable figure acquired for day case surgery, which is less than 2%. Thus, at present, septoplasty should be performed as a short-stay procedure. If the present trend continues, however, more and more surgical procedures will be performed on an ambulatory basis in Japan.