Your Questions About Inpatient vs. Outpatient Surgery Answered

If you or a loved one is considering surgery now or in the future, you will probably hear about inpatient vs. outpatient options. Understanding the differences between the two and why each would be recommended is key to setting your expectations for the surgery and its outcome. This comprehensive guide will help you better understand the surgery differences.

Your Guide to Inpatient vs. Outpatient Surgery: Understanding Your Options

What is the difference between inpatient and outpatient surgery?

You are considered “inpatient” if your doctor has written an order to admit you to the hospital, regardless of the length of the stay.

You are considered “outpatient” if your doctor hasn’t written an order to admit you to the hospital and you are getting:

• Emergency department services
• Observation services
• Outpatient surgery
• Lab tests, X-rays or other hospital service

In these instances, even if you end up spending the night in the hospital, you are still considered “outpatient” if your doctor hasn’t written the order to admit you to the hospital.

What Determines If You Need Inpatient or Outpatient Surgery?

The decision between the two depends on several factors, including the complexity of the surgery, your health status, and the level of monitoring and care you may require post-surgery.

The decision for inpatient hospital admission is based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need two or more midnights of medically necessary hospital care. But, your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.

In general, less complex surgeries with a lower risk of complications are often done on an outpatient basis.

What Is Inpatient Surgery?

These types of surgeries often require a longer recovery time and more intensive monitoring, requiring patients to stay in the hospital for a period of time after the procedure. It may also be recommended for patients with certain underlying health conditions or those at a higher risk for complications during or after the surgery.

Examples of inpatient surgery include procedures such as:

• Open-heart surgeries
• Organ transplants
• Lung procedures
• Complex gastrointestinal surgeries

What Is Outpatient Surgery?

Outpatient surgeries are typically less invasive and have a lower risk of complications, allowing patients to go home on the same day. Outpatient surgery may also be recommended for patients in good overall health who have a strong support system at home to assist with their recovery.

Examples of outpatient procedures include procedures such as:

• Cataract surgeries
• Gallbladder removals
• Hernia repairs
• Colonoscopies
• Tonsillectomies

What Are the Benefits of Inpatient vs. Outpatient Surgery?

Benefits of Inpatient Surgery:

• 24/7 monitoring and care
• Access to specialists and medical equipment
• More time for recovery before going home

Benefits of Outpatient Surgery:

• Less time spent in the hospital
• Lower cost compared to inpatient care
• Reduced risk of hospital-acquired infections

Where Are the Surgeries Performed?

Inpatient surgeries are typically performed in a hospital setting, where patients have access to specialized medical equipment that can allow for immediate intervention in case of any complications during or after the procedure.

In contrast, ambulatory surgery centers, outpatient surgery departments of hospitals or clinics often perform outpatient surgeries. These facilities are equipped to handle routine procedures that do not require overnight stays, allowing patients to return home on the same day.

Are There Different Physicians for Inpatient vs. Outpatient Surgery?

Physicians specializing in inpatient surgery are often hospital-based surgeons with experience in managing complex cases and providing postoperative care in a hospital setting. These surgeons work closely with other medical professionals, such as anesthesiologists and nurses, to ensure the best possible outcomes for their patients.

In contrast, outpatient surgery may be performed by a wider range of physicians, including general surgeons, ophthalmologists, gynecologists, and gastroenterologists. They are trained to perform less complex surgeries that do not require an overnight hospital stay.

Is There a Difference in the Cost Between Inpatient and Outpatient Surgery?

In general, inpatient surgery tends to be more expensive due to the higher level of care and resources provided in a hospital setting. Patients may incur additional costs for room and board, medical supplies, and specialized monitoring during their stay.

Does Insurance Cover Inpatient and Outpatient Surgery?

Insurance coverage can vary depending on the type of procedure, the patient’s insurance plan, and whether or not the facility is in-network. In general, most insurance plans will cover medically necessary surgeries, whether they are performed on an inpatient or outpatient basis. However, patients may be responsible for copayments, deductibles, or coinsurance based on their specific insurance policy.

Does Medicare Cover Inpatient and Outpatient Surgery?

What Medicare covers depends on whether you are considered inpatient or outpatient. As usual, you will be responsible for your deductible and any coinsurance or co-payments. After those costs are met, if you are considered outpatient (i.e., not admitted to the hospital), Part A pays nothing while Part B covers outpatient services and doctor services.

If your doctor writes an order for inpatient admission and you are admitted to the hospital, Part A covers your inpatient hospital stay and Part B covers your doctor services. In instances where you could be treated on an outpatient basis and then your doctor later admits you to the hospital, Part A would then also cover related outpatient services. It’s important to be aware of the status of your stay so that you understand what expenses Medicare will cover.

Patients should also check with their insurance provider or Medicare plan to understand their coverage and any potential costs associated with their situation.

Talk to North Carolina Specialty Hospital About Your Options

If you discover you need surgery, your decision between inpatient vs. outpatient surgery ultimately depends on your unique situation and the recommendations of your healthcare provider.

At NCSH, our experts can help you determine the best treatment. Learn more about the inpatient and outpatient surgical procedures we perform, including specialties in orthopedics, ophthalmology, ear, nose, and throat, sports medicine, oral surgery, plastic surgery, general surgery, reconstructive surgery, joint replacement, and more. With our high rankings in quality measures and patient satisfaction, you can relax knowing you’ll get the information you need and the desired outcome.