India calls for safe and cost-effective short-stay surgeries

According to a World Journal of Surgery study conducted on patients in Mumbai who were availing the employees’ health scheme, 4642 surgeries were performed per year for a population of 88,273 in the city. The study analyse the surgical procedures performed in 2017 and 2018 under the free and equitable health scheme to arrive at an estimate of surgical needs for the national population. The most common surgeries that were performed included cataract (22.8%), caesareans (3.8%), surgeries for fractures (3.27%) and hernia (2.86%). Out of these 44.2% of surgeries belonged to essential surgeries. One of the interesting factors of the study is that estimated 3646 surgeries would be required per 100,000 Indian population per year. 

In fact, one can argue that in some sense, these figures though illustrative, represent just the tip of the iceberg. Several studies conducted globally suggest that a very tiny minority of the world population is able to access surgical care. This divide gets particularly exacerbated in countries where large chunks of the population reside in rural areas. There is also adequate consensus that effective and accessible surgical care plays a crucial role in managing the disease burden of a population. Given that, India has a significant population suffering from several ailments that can be easily managed through effective surgical care, it becomes a matter of utmost attention and urgent policymaking for all stakeholders that short-stay surgeries are made cost-effective, efficient, and beneficial for all. It must be pointed out that ignoring conditions that are surgically treatable such as obstructed labor or cataract can cause premature deaths. Thus, focusing on managing surgical interventions is an important area of concern if one were to look at the health needs of the population. 

However, certain challenges remain. Patients can be skeptical of such methods for various reasons. First, surgeries are presumed to be costly by patients both in terms of the costs incurred as well as the loss of wages caused by the duration they spent away from work at the hospital. Second, many times, the lack of proper post-operative care can lead to negative consequences, which damages the credibility of the procedure thereby making other patients hesitant in opting for such solutions. Third, is the lack of a robust surgical care ecosystem and infrastructure that can swiftly facilitate short-stay surgeries, which can take care of the above-mentioned challenges.

Short-stay surgeries refer to those where patients can be discharged from the hospital within 24-48 hours of surgery completion. Several procedures related to diagnostics, gynaecology, ophthalmology, gall bladder, and laparoscopy among others can be classified under this category. Short-stay surgeries need not be heavy on the patient’s pocket and the presence of good post-operative care can ensure that the patient can resume their everyday activities quickly.

Currently, short-stay surgeries are limited to big specialty hospitals and top cities of the country. However, there is an urgent need to take this model and popularise it among semi-urban and rural populations where majority of people are unfortunately ignoring secondary care or short-stay surgeries. Also, the need of the hour is to shift the elective surgery burden from bigger hospitals so as to prepare them better for life-saving medical services and emergency situations. 

The advancement in technology and medical science has made surgeries less painful and non-invasive. Thus, even recovery times have reduced and it is indeed possible to restore any loss of mobility or activity due to surgery at a faster rate. Certainly, these advancements have come at a cost, albeit not everyone can afford them. However, the cost must not be an obstruction for populations that need and deserve surgical care but are unable to access it. 

It is a well-established fact among medical practitioners that while prevention is ideal, it may not always be possible and hence, there will always be a need for clinical – including surgical – interventions. Yet, it is equally true that there is a kind of attrition and an attempt at delaying, if not escaping, surgeries prescribed by doctors. Several fears plague a patient’s mind while making a decision about the same. For severely life-threatening diseases, the criteria used by patients for decision-making are very different from the criteria involved in taking decisions related to other surgeries. One crucial factor here is the word of mouth that patients hear from their other peers. A negative commentary from those suffering from similar diseases can cloud a prospective patient’s mind with doubts and uncertainty. This can lead to them dilly-dallying on options for a surgical solution that can help them get better. This bottleneck can only be resolved by effective communication between the patient and the doctor as well as having a strong bond premised on trust.

A clear articulation of what surgery is being prescribed, how will it benefit them, and how must it be managed in the aftermath are some of the key points that a doctor must describe in detail to their patients in order to build their faith in the process and the system. Sometimes, even if patients are financially capable of affording surgeries, other fears creep up in their minds which can prevent them from accessing solutions for a better quality of life.

A strong infrastructure that takes into account the needs of every stakeholder in the process is necessary to take short-stay surgeries to even the remotest districts of the country. A robust short-stay surgical care ecosystem that aims at deeper penetration of surgical facilities to masses, brings cost-effectiveness to surgical procedures, and ensures high-level safety standards has the potential to motivate patients to further stop ignoring secondary care or short-stay surgeries. However, for that infrastructure to be utilised effectively requires the patient’s consent and will to take responsibility for their recovery. Moreover, that can only be successfully achieved by ensuring clear and transparent communication between the medical fraternity and the patients.