To cut costs, many complex surgeries that once involved an overnight stay in the hospital are now done on a same day basis in ambulatory surgery centers. Surgical techniques have evolved to the point where even elaborate joint replacements can be safely performed outside of a hospital. But approaches to post-operative patient care haven’t kept pace with the longer, more painful, and riskier at-home recoveries which come along with the shift to more same day surgeries.

The New York Times recently did a piece about grueling and even disastrous recoveries from Brazilian butt lifts, bringing needed attention to the importance of having skilled at-home care following complex, invasive outpatient procedures like this one. I want to amplify this message. All the more so because surgeons almost never paint a clear picture for their patients about just how painful and disabling their recovery processes can be.

For example, surgical aftercare instructions are written in bland language such as…

…”your XYZ area will be painful for two to four weeks,” or “you will probably need to take one to two weeks off work”…

When what’s behind this bland language could be more realistically stated as…

…”your recovery will be so painful that you are unlikely to be able to sleep through the night for at least a week,” or “given the pain level and likely need for narcotic pain control, you will be so compromised that you are unlikely to get work done for several weeks.”

As a result, most patients are caught off guard as soon as they’re discharged.

Overnight recovery services have sprung up to deal with the onslaught of patients that are wheeled out of surgery centers only an hour or two after leaving the operating room. But patients need to know what they’re getting into with these outfits. Most importantly, many don’t employ registered nurses, relying instead on medical assistants that are often inexperienced. (The New York Times piece offers some nightmarish examples of how easily things can go off the rails when one picks the wrong recovery service.)

Furthermore, even at the most expensive recovery facilities, care providers usually have many patients to look after, and staffing levels aren’t as carefully managed as they are in hospitals.

When patients decide to recover on their own at home, they often don’t plan carefully enough for challenges involving meal preparation, transportation to and from post-op appointments, wound care, pain control, body positioning, medication reminders, bathing, and toileting — all of which are made much more difficult when lying on one’s back in enormous discomfort. Even when patients have sufficient funds to hire qualified private duty nurses for a night or two, they frequently neglect to amass all the supplies and equipment needed for their care, leaving their recovery nurses in a bind.

Of course, the most important challenge during recovery is spotting early warning signs of a complication or medical emergency. These include extreme or lopsided swelling, excessive bleeding, long-lasting fever, chest or leg pain, breathing difficulties, and uncontrollable vomiting. It’s worth taking a look at this discharge checklist from the Care Partner Project for more information about symptoms that warrant medical help.

To minimize the risk of complications and speed recovery, surgeons provide post-operative care instructions to their patients. But in my experience, most patients don’t read these handouts carefully enough, if at all. Even worse, having reviewed hundreds of them, I have to tell you that most post-operative instructions are woefully inadequate, offering only the most basic guidance and very little in the way of “if this happens, then do this.”

As a result, patients recovering at home can easily grow anxious as questions pile up, and possibly even miss early signs of complications. I have even seen patients admitted to the ER after experiencing post-operative complications because they didn’t want to make a fuss and delayed calling their surgeons. It’s worth taking a look at this checklist from the Care Partner Project for more tips about helping a loved one recover from surgery.

Years ago, seeing the explosive growth of invasive outpatient surgeries, I co-founded a company that pioneered a new approach to aftercare, providing unlimited, on-demand surgical patient telemanagement via phone, text and video chats. Our remote nurses caught a number of hematomas and other complications that our patients recovering at home had simply ignored, thereby preventing emergency ER visits or worse.

Bottom line? If you’re planning to undergo complex, invasive same day surgery, please have a safe and realistic plan for your aftercare, including reading your post-operative instructions and asking lots of questions before your big day. If you’re considering using an aftercare nurse or facility, you need to carefully evaluate your potential providers. And of course, during your recovery, don’t hesitate to call your surgeon’s office whenever you have a question or concern, day or night. Please.

You should know that the vast majority of aftercare service providers are good at their jobs. Still, as I usually write at the end of my posts, it’s best to trust but verify. And if you’re planning to go it alone, by all means, make sure that your friends and family are well prepared to help during your recovery. Good luck!

Nothing in this article should be relied on for medical advice.

Copyright © 2025 by Monica Berlin