Will Outpatient Surgeries Finally Take Off in India?

By Arunima Rajan

Outpatient surgeries show signs of revival in India, but lack of awareness is still a barrier

Outpatient surgeries have historically struggled to gain traction in India. However, the benefits of this model—reduced hospital stays, greater convenience, and cost savings—are undeniable. Recently, there have been clear signs that the outpatient surgery sector in India is finally on the rise.

Dr M Sudhakar Rao, a Consultant in Cardiology at Manipal Hospital, Sarjapur Road, Bengaluru, highlights that daycare surgery is a relatively recent addition in numerous hospitals. "This service enables patients to undergo essential procedures without requiring hospital admission. Typically, patients arrive at the operation theatre or cardiac catheterization lab early in the morning, undergo the procedure, and are monitored for a few hours post-operation. If their recovery is satisfactory, they are discharged with detailed post-operative care instructions by the evening," explains Rao.

Coronary angiograms have historically been the most frequent daycare cardiology procedures. However, the range of procedures now includes simpler coronary angioplasty, electrophysiology interventions, pacemaker implantations, and specific paediatric device closures. These procedures are generally appropriate for a subset of patients with particular conditions, such as normal or near-normal heart function and the absence of complex diseases like multi-vessel disease. "Daycare procedures offer the significant advantage of allowing patients to recover in the comfort of their homes, which is especially beneficial in light of the current severe shortage of hospital beds," adds Rao.

India's ambulatory surgery centre market, which stood at around $1.73 billion in 2022, is poised for significant growth. By 2030, it's expected to almost double, reaching $3.48 billion, driven by a robust CAGR of 9.1% over the forecast period from 2023 to 2030.

Patient Perspective

The COVID-19 pandemic has accelerated the adoption of daycare surgeries, reflecting a broader shift in healthcare trends. Neeraj Lal, COO & Unit Head of Apollo Hospitals in Gujarat, notes that patients increasingly favour shorter hospital visits. "Previously, patients would stay in the hospital for 3-4 days post-surgery. Many surgerieare completed within a few hours, with patients typically discharged by the evening. This reduces the risk of hospital-acquired infections and lowers overall treatment costs," says Lal. He highlights that around 25-30% of surgeries at Apollo Hospitals are now performed on a daycare basis, covering various specialities.

Lal further points out that India faces a noticeable shortage of hospital beds, a challenge that daycare surgeries help to mitigate. "The rise of minimally invasive surgeries, such as arthroscopy, has reduced the turnaround time for hospital beds. This trend benefits both hospitals and patients, offering a cost-effective solution that increases bed availability and optimizes resource utilization," he explains. Lal also mentions that in cities like Ahmedabad, many patients travel from distant locations, such as Jodhpur and Udaipur, for these procedures. "Patients arrive in the morning, undergo surgery, and return home by evening. This model has become increasingly popular, particularly for weekend surgeries or daycare procedures."

Technology

Technological advancements have played a crucial role in the growth of outpatient surgeries in India. Innovations such as minimally invasive cardiac surgery, robotic surgery, and the integration of Artificial Intelligence have made these procedures safer, quicker, and less invasive, making outpatient surgeries a viable option for more patients.

"Cost-effectiveness is a significant driver behind the popularity of outpatient surgeries," Lal adds. "Shorter hospital stays mean fewer antibiotics are needed, reducing medication costs and the overall hospital bill. Additionally, as more doctors adopt robotic surgery, we expect the costs of these procedures to decrease over time. Although robotic surgery is currently more expensive than traditional open or laparoscopic surgeries, increased usage will likely drive down costs."

The shift towards daycare surgeries marks a significant evolution in healthcare delivery. This model combines technological advancements with a patient-centred approach. As more hospitals adopt this model, the benefits of reduced costs, lower infection risks, and increased patient satisfaction are becoming increasingly apparent.\

Dr Jayanth H is a consultant surgical gastroenterologist and robotic surgeon at Gleneagles BGS Hospital, Kengeri, Bengaluru. "The primary advantage of daycare surgery is the reduced cost, as it eliminates the need for an extended hospital stay, which can be expensive. Additionally, patients benefit from a lower risk of hospital-acquired infections as they spend less time in a medical facility. The comfort of recovering at home, surrounded by loved ones, is another significant benefit. Moreover, the quick turnover in daycare surgeries frees up hospital resources, allowing for better utilization of healthcare facilities. However, there are some downsides to consider. Not all surgeries are suitable for daycare; more complex procedures require prolonged monitoring and recovery time, necessitating an inpatient stay. Additionally, the daycare procedure requires the patient to have easy access to a good healthcare facility in case complications arise after discharge.

Advancements in surgical techniques, anaesthesia, and post-operative care are driving the growing popularity of daycare surgery, making it a viable option for many procedures. This will, in turn, improve patient outcomes and overall healthcare efficiency," explains Jayanth.

"Advances in healthcare is a never-ending process," notes Dr Ganesh Shenoy, Director, Department of Surgical Gastroenterology, Minimal Access and Bariatric Surgery, Kauvery Hospitals, Bangalore. "With the growth of I.T. and the need of patients, newer technology has developed to ensure safety and faster recovery for surgical patients. With the advent of laparoscopic surgery over the last four decades and robotic surgery for a decade, gadgets to easily perform major surgery have influenced outpatient surgeries. Currently, 60-75 per cent of surgeries in our hospital are outpatient surgeries," explains Shenoy.

Human Resource

"In the OPD procedure area, only experienced staff working in the same function are deployed. This enables them to understand the requirement of a daycare procedure," says Yashpal Rawat, Facility Director, Fortis Memorial Research Institute, Gurugram. He adds that they have had very promising feedback from such patients. "Due to fewer stays, the chances of service gaps and conflicts are also lower. Generally, our patients who have undergone an OPD procedure have gone back with smiling faces only to return for a follow-up," he explains.

NHS Story

John Appleby, Chief Economist at theKing's Fund, offers a compelling case study from the U.K. that could serve as a blueprint for India's healthcare system. Established in 1897 by the then Prince of Wales, The King's Fund has consistently led efforts to improve health and care. In a 2015 report, Appleby detailed how day surgeries in the U.K. grew from just 7% of procedures in 1974 to nearly 35% by 2013, thanks to strategic investments like dedicated surgery units. This shift enhanced patient outcomes and resulted in significant cost savings—an estimated £2 billion in 2013 alone. As India explores similar paths, the U.K.'s experience underscores the potential to achieve greater efficiency and better care outcomes by expanding day surgeries.

The U.S.

The U.S. ambulatory surgery centre market was valued at $43.70 billion in 2022 and is projected to grow to $75.20 billion by 2030, with a compound annual growth rate (CAGR) of 7.1% from 2023 to 2030. In 2019, approximately 11.9 million major ambulatory surgeries were performed in hospital-owned facilities in the U.S., translating to a rate of 36.1 surgeries per 1,000 population. The number of ambulatory surgeries has grown consistently over the years. For instance, the volume increased from 13.4 million surgeries in 1995 to 19.2 million in 2018.

Christoph Dankert is the Chief Network Officer at Carrum Health. "Many surgeries can now be safely done in an ambulatory surgery centre setting. While comfort level varies across surgeons and clinical teams, the general trend is that more and more surgeries have moved in this direction, which the COVID pandemic has accelerated. Take total joint replacement - pre-pandemic, maybe one-quarter of the surgeries happened in a hospital outpatient setting, let alone an ASC. This has reversed to where 80-90% of joint replacement surgeries now take place in an outpatient setting. Many surgeons will perform almost all of their cases in an ASC. Advances in better, less invasive surgical techniques, improved anaesthesia protocols and more pre-operative preparation have together enabled this trend. It does come with challenges, as patients need to be prepared much more thoroughly, and a clear support plan must be provided after the surgery. Even things as simple as who picks you up from the surgery centre need to be thought through carefully," concludes Dankert.

Agile organization

Dr Hany Demian is a minimally invasive/chronic/spine surgery expert. He is the CEO of the BioSpine Institute in Florida and the CEO and Co-founder of Pain Care Clinics/PCC in Canada. The BioSpine Institute specializes in minimally invasive outpatient spine surgery. Demian claims that his institute offers a new microscopic back surgery through a 4 mm incision, with patients walking out pain-free after 20 minutes and being able to go back to their lives in just 48 hours.

"Day surgical centres significantly reduce the downtime pre/post-surgery, so patients don't have to spend days or hours in a hospital environment before or after the surgery.

In addition to extremely short downtime for recovery, patients usually walk out from their surgery the same day (a few hours after) and, in most cases, return to their life in a few days. At BioSpine Institute, we encourage patients to walk right after any surgery, and they can fly back to their homes in 2-3 days.," he explains. Day surgery centres offer more advanced, state-of-the-art procedures and technology. This is due to their sheer size, which makes them quite agile in making decisions quickly and readily adopting new technologies and techniques. For example, at the BioSpine Institute, we have developed a seamless cycle to bring new technology and were able to implement it in 30-60 days, which is a record time. We brought the microscopic spine surgery "micro-invasive" from an idea to implementation in less than 60 days. The same cycle would take a traditional hospital at least a year. That reflects on the patients' fast access to new services that we can offer at BioSpine Institute and other day surgery centres," he concludes.

Ultimately, patient education will be essential for the ambulatory surgery sector in India to achieve its full potential. Lakshmi points out that her friend's mother was also undergoing cataract surgery at the same time. However, they didn't trust a small clinic to perform the surgery on a senior citizen. Even though the doctor used to work in the same hospital, they were concerned about infection control and whether it would be covered under their insurance plan. Only when these barriers are addressed will ambulatory surgery centres finally be able to gain traction and extend their benefits to a broader population.