NEWPORT BEACH — The beads of perspiration that formed on Dr. Mark Anton's furrowed forehead glistened under the bright light bathing the operating room. Flanked by two masked nurses, he quickly completed the surgery.
The patient, still unconscious, was soon wheeled into the post-operation suite. Within hours she was sent home to recuperate.
Home? After a two-hour surgery? That, indeed, is what the doctor ordered.
"Patients would rather have that non-hospital feel," said Anton, a plastic surgeon at the newly opened Newport Beach Surgery Center, one of a growing number of ambulatory surgery centers that have been providing a lower-cost alternative to hospital stays that average more than $800 a night.
Health care experts said that cost concerns and an array of high-tech medical devices have spurred a whole new industry: free-standing operating rooms that can accommodate patients who need surgery routine enough to eliminate the requirement for an extended stay in a hospital.
As the health care industry evolves, most experts agree that hospitals, as we know them today, will be a thing of the past. Instead, the health system will feature "core" hospital units, where only the gravest of illnesses and injuries such as brain cancer and head trauma will be treated, health care experts say.
Spinning out from the core, experts say, will be a network of community-based institutions that will treat a majority of medical cases in a more cost-effective way.
In short, managed care will be the watchword in the medical industry for the foreseeable future, experts say. That point was driven home during the presidential campaign, when all three major candidates discussed the spiraling cost of health care and ways to control it.
A major component of this ongoing evolution is the ambulatory--or outpatient--surgery center, where operations can be performed on patients without having to admit them into a hospital.
"Up until now, hospitals have been the hub of medical care," said Dr. Robert Olson, a one-time Hoag Hospital anesthesiologist and now a director at the Newport Beach Surgery Center. "Hospitals are the least cost-effective place to care for most people."
Ambulatory surgery centers, as the federal government calls them, have been in existence for more than a decade and have slowly caught on as viable alternatives for many types of surgery. For the first time, more than half of all surgical procedures performed in 1988 were conducted in such facilities, while the total number of surgeries inside a hospital has steadily declined.
By the turn of the century, experts estimate, about 70% to 80% of all surgeries performed in the United States will be done outside the traditional hospital setting. And with current technology, safety and quality of care is not compromised, state and private health experts said. The shift will ultimately leave hospital operating rooms to handle only such dire operations as open-heart surgeries and kidney transplants.
Meanwhile, the number of outpatient surgery centers is expected to grow by as much as 15% a year. Annual revenue is expected to surpass $1.2 billion in 1993.
"They really streamline medicine," said Lisa Remington, editor and publisher of the Remington Report, a Laguna Niguel medical industry newsletter that researched the growth of ambulatory surgery centers in a recent edition. "They cut out a lot of the fat."
Remington and other health care observers said that the different types of surgical procedures performed on an outpatient basis have soared, from about 200 separate procedures 10 years ago to more than 2,000 today.
Once only used for such simple operations as wart removals and foot surgeries, physicians now conduct more complicated medical procedures on an outpatient basis, such as gallbladder removal, hernia repair, appendectomies, hysterectomies and arthroscopic joint surgery.
The list will grow even longer as medical device manufacturers discover improved treatment methods.
For instance, newly developed "cold" laser technology, manufactured by such Orange County companies as Trimedyne Inc. and Advanced Interventional Systems Inc., has made it possible to clear blocked arteries near the heart. Such a procedure, which only requires a small incision to insert the laser, may some day make open-heart surgery a thing of the past.
And such equipment as MRIs and CAT scans, which use computer and X-ray technology to look inside a patient, can make diagnoses possible without exploratory surgery.
"I believe (that) toward the end of the century, we will really begin to enter a century of bloodless surgery, which would be wonderful," said Stephanie Anders, senior associate for ambulatory care services at UCI Medical Center in Orange.
