Bimax as an outpatient procedure

[face_backward]

I've consulted with four surgeons about getting bimax with counterclockwise rotation to treat my sleep apnea. 

The first three all told me the procedure would be performed in a hospital, that I'd have to stay in the hospital between 2 and 5 days, and the hospital fees, if I were paying out of pocket, would run in the several tens of thousands of dollars. 

The fourth told me he could do the operation in a surgery center and send me home the same day, with facility and anaesthesia fees totaling less than $5k.  He said the first few days would be rough, but since I was otherwise in good health, I should be fine without any hospital care as long as I made an effort to stay hydrated.

The idea that I could walk out same day and save 25 grand off the lowest facility estimate I got from anybody else, even if it means some additional discomfort in the initial recovery, sounds too good to be true.  Materials I received from one of the surgeons who would operate in a hospital explained that I could leave as soon as I was ambulatory and able to remain hydrated -- but also that patients usually spend 3-4 days in inpatient recovery.  I'm not understanding why I should expect that to take 3-4 days, especially when this other surgeon is willing to release me immediately.

Anybody here have experience with jaw surgery in a surgery center on an outpatient basis?  This fourth surgeon is a fairly recent graduate who trained under a guy who published some papers on outpatient orthognathic surgery, so maybe it's sort of a cutting-edge thing.

[kavan]

Some surgery centers (places not in hospitals) don't have licencing for the over night stays. No idea why other than some stupid bureaucratic thing where if they call themselves an 'outpatient' surgery center, then you gotta get out and can't stay a few nights.  Look into hiring a private nurse for the first few days like if you need drain changes or have to be transported to a hospital.

[sleepypies]

As kavan suggested, I think hiring a private nurse would be a good compromise between staying 2-5 days in a hospital at an exorbitant cost versus being discharged same day from a surgery center and then suffering at home without a medical professional. I had top jaw surgery only and was in the hospital for roughly 22 hours (I stayed overnight). I went into the surgery thinking that the overnight stay was unnecessary (I'm also very healthy), but honestly I was VERY glad to have that around the clock nurse care that first night even though I had no major issues.

I ingested a lot of blood during the surgery and after I woke up I was vomiting blood for several hours. Due to this, I couldn't keep anything down. Without the IV, and later the urging of the nurses, I doubt I would have received enough fluid to stay hydrated. The nurses also made sure I was receiving anti-nausea medicine and pain killers (delivered as suppositories because as stated above I couldn't keep anything down). They also fashioned a nose bandage held in place with an elastic band because my nose wouldn't stop bleeding (it kept bleeding for 48 hours so I was happy to use this trick when I was discharged). Once I got home, I was able to take a very short walk with my dogs and the rest of the recovery was pretty easy. I don't think that would have been the case had I become super dehydrated in those first 22 hours.

Again, I don't believe I had any major reaction to the surgery, but I've read accounts of people projectile vomiting after the surgery and experiencing way more pain than I did. Without the nurses care, I think I would have been incredibly anxious and my mental state would have probably taken a big hit, which can make recovery much harder. As much as my husband tries, I don't think he could have helped me the way a trained medical professional could, and I was incredibly glad to have that assistance even though I didn't think I would need it.

[face_backward]

Followup: I discussed this surgery-center/outpatient idea with one of the other surgeons I'd consulted with before, who has more experience and whose opinion I hold in higher regard.  He told me in no uncertain terms that outpatient bimax was a terrible idea, that the surgeon offering it was being irresponsible, and that it would eventually catch up with him.  He said he's seen too many instances where the patient would have been in serious danger if they'd not been in a hospital during and after the surgery.  Even with healthy people, s**t happens and you can die, post-op bleeding and whatnot, and he would never put his patients at risk by sending them home immediately -- even 23-hour watch was not enough, in his opinion.  This surgeon has also had this surgery done on his own face, and says he absolutely wouldn't have wanted to be at home for the recovery. 

It was enough to put me off of it, especially with a surgeon who hasn't been in practice very long, like this one who suggested it hasn't.