Correspondence  |   September 1999
At-home Recovery after an Anesthetic 
Author Notes
  • Department of Anesthesia
  • VA Medical Center
  • Milwaukee, WI 53295
Article Information
Correspondence   |   September 1999
At-home Recovery after an Anesthetic 
Anesthesiology 9 1999, Vol.91, 887. doi:
Anesthesiology 9 1999, Vol.91, 887. doi:
In Reply:
—You believe we should concern ourselves with long-term patient well-being, such as how quickly they return to normal function at home and at work? Dr. Blatt has expressed too much compassion for and understanding of a societal issue. Our professional decisions have been constrained by managed care and cost-containment issues that lead us to choose clinical pathways that include fast-tracking an increasing percentage of elective surgical patients. We cannot ask our phase I recovery nurses to attend to our postoperative patients because they, and their location, are too expensive. Rather, we arouse our patients suddenly from their comfortable sedation and hypnotic state, avoid opioids for fear of postoperative nausea and vomiting, shuffle them to a step-down unit, and hope that being with family versus  nurses gets them home more quickly. If postoperative nausea and vomiting does occur, we use the least-expensive antiemetic, although we have been told it has greater side effects than the more costly alternative. We tell patients not to drive a car and then hustle them out the door with the assumption that they are happy to be gone.
In all seriousness, Dr. Blatt brings up the important issues of patient satisfaction and street fitness. Because patient safety and early outcome has not been compromised by speeding up recovery from anesthesia and other cost-saving measures, there has been no real demand to determine if our patients are happy and functional. These studies are urgently needed. If we identify a “process” that improves the return to normal daily activities but that costs us more time or dollars, the battle will begin. Third-party carriers would be challenged not only by the data, but by patient involvement in choosing hospitals, doctors, and/or Health Maintenance Organization plans based on availability of this better “process.”
Beyond the outcome variables of total hospital costs and costs to third-party carriers, there is the relatively unstudied cost to society. We agree with Dr. Blatt that the return to full mobility, activities of daily living, and daily decision-making are essential outcome measures that will most likely be achieved best with the newer, less soluble volatile anesthetics, the short-acting local anesthetics and adjuvants, and the more efficacious antiemetics. These agents may add to hospital costs but also may hold the greatest potential to improve the ultimate cost to society. Yes, these studies are urgently needed, but they remain on the back burner.