Site of Service Outcomes Comparisons
Perioperative Medicine
Published: August 2024
Finding: “Our findings of a very low admission rate despite many patients with higher age, ASA classification, and BMI, suggest that it may be feasible to expand ASC eligibility to even higher-risk patients.” [Overall, 53,185 cases were identified for the 7-year period. The incidence of unplanned hospital admission over this period was 0.09% (95% CI 0.07–0.1122%; ranging from 0.05 to 0.12% per year).]
American Journal of Surgery
Published: April 2019
Finding: Authors reviewed procedures in an ASC vs. HOPD, specifically looking at components of total case time during surgery to examine operating room efficiency. Of the 220 procedures examined, they found better turnover time, less ancillary time, shorter procedure time, earlier exit times, and less nonoperative time, concluding that outpatient procedures in the ASC are more efficient than those performed in the HOPD.
Health Services Insights
Published: April 2017
Finding: Examining a sample of 88 outpatient procedures using a 2008–2012 private claims insurance database, researchers found significantly higher 7- and 30-day hospital admission rates following procedures in HOPDs vs. ASCs and physician offices.
7-day risk adjusted readmission | ASC: 0.82%, PO: 1.57%, HOPD: 1.71%
30-day risk adjusted readmission | ASC: 2.03%, PO: 2.72%, HOPD: 2.98%
Anesthesia & Analgesia
Published: February 2016
Finding: Looked at New York State ambulatory surgery discharge records 2002–2011 for ICD-9-CM code 995.86 (indicates malignant hyperthermia due to anesthesia). Rate of MH found to be 0.18 per 100,000 discharges, less than hospital rate (1 per 100,000) and national rate (1.3 per 100,000).
ASC Cost and Price Effects
Medical Care
Published: January 2019
Finding: ASC availability was associated with decreases in overall outpatient procedure prices, mostly due to reductions in the prices paid to hospital outpatient departments. Results suggest that competition from ASCs benefits consumers through lower prices for outpatient procedures.
The Journal of Minimally Invasive Gynecology
Published: November 2017
Finding: Authors looked at outcomes for a large series of total hysterectomies performed between 2010 and 2017, with cost implications in mind. They found that minimally invasive hysterectomy in am ASC is feasible and reproducible, with an average cost roughly $5,000 less than performance in a HOPD.
Orthopedic Procedures
Arthroplasty Today
Published: November 2018
Finding: Retrospective review of 105 patients who underwent outpatient THA or TKA following an outpatient protocol compared to inpatients from the same time period. Outpatient readmission and complication rates (0.95%, 1.9%) were better than inpatient rates (3.7%, 2.9%). Authors conclude that Outpatient THA and TKA in a well-selected patient is feasible in an academic multidisciplinary tertiary care hospital, with complication rates approximating inpatient surgery. The findings reported can be used to further optimize outpatient arthroplasty protocols.
The Journal of Arthroplasty
Published: July 2018
Finding: Although satisfaction was high in both outpatient and inpatient groups, when differences were present, patients favored outpatient surgery in the ambulatory surgery center.
The Journal of Arthroplasty
Published: March 2018
Finding: A review of 569 outpatient unicompartmental knee arthroplasties performed 2012 to 2016 (288 ASC, 281 HOPD) revealed no difference in overall complication rate between the two settings.
The Journal of Arthroplasty
Published: February 2018
Finding: Authors compared 43 inpatients and 43 outpatient TKAs between 2010 and 2015 by a single surgeon. Patients were given a diary to complete at post-discharge intervals, and study tracked 90-day complications, readmissions, and ED visits. Outpatient TKA in selected patients produced similar short-term and 2-year patient-reported outcome measures and a comparable 90-day post-discharge hospital resource utilization when compared to an inpatient cohort, supporting further investigation into outpatient TKA.
Journal of the American Academy of Orthopaedic Surgeons
Published: January 2018
Finding: Our findings are consistent with currently reported outpatient hospital-based data and illustrate the safety of outpatient shoulder procedures at a freestanding ambulatory surgery center in Medicare-age patients.
The Bone and Joint Journal
Published: January 2018
Finding: Authors reviewed 1,472 total hip arthroplasties (THAs) performed at an ASC between 2013 and 2016. They found a low complication rate (2.2%) despite the fact that 44% of the patients observed had one or more major comorbidities. Based on this, they conclude that in their population comorbidities was not associated with medical or surgical complications and that outpatient THA is safe for a large proportion of patients without the need for a standardized risk assessment score.
Orthopedic Clinics
Published: January 2018
Finding: 65% of hand surgeons report doing most of their surgery at an ASC, and in 2006, 49% of carpal tunnel release procedures were done in ASCs (up from 16% in 1996). Use of ASCs for hand surgery is more cost-effective and efficient than an inpatient facility, with a low (0.2%–2.5%) complication rate.
The Journal of Shoulder and Elbow Surgery
Published: January 2017
Finding: Comparing two samples (30 patients matched for age/comorbidity) of patients undergoing total shoulder arthroplasty at an ASC and an inpatient hospital, there was no significant difference in 90-day episode-of-care complication rates such as hospital admission/readmission.
The Journal of Bone and Joint Surgery
Published: April 2016
Finding: A retrospective review of 28,000+ cases found an overall low (0.20%) rate of adverse events (defined as serious complications leading to patient harm or additional treatment).
Spine Proedures
Journal of Personalized Medicine
Published: March 2023
Finding: Minimally invasive TLIF can be performed safely and efficiently in the ASC in Medicare-age patients.
Spine
Published: January 2019
Finding: There was no difference between 30-day complications, readmission, and reoperation rates between inpatients and outpatients who underwent a single-level cervical TDR. Furthermore, the overall 30-day complication rates were low. This study supports that single-level cervical TDR can be performed safely in an outpatient setting.
International Journal of Spine Surgery
Published: October 2018
Finding: Authors compared a sample of ASC patients, hospital outpatients, and hospital inpatients undergoing cervical disc arthroplasty (CDA). They find that surgeries in ASCs are of shorter duration and performed with less blood loss, concluding that both 1- and 2-level CDAs may be performed safely in ASCs.
Spine
Published: July 2018
Finding: Authors examined TRICARE (military) claims from 2006 to 2014 for three common spine procedures. The primary outcome assessed was emergency department (ED) utilization at 30- and 90-days post procedure (roughly 50k patients met selection criteria). They found that use of outpatient spine clinic services was the only factor independently associated with significant reduction in likelihood of ED utilization at 30- and 90-days.
Neurosurgery
Published: March 2018
Finding: Following a comprehensive review of clinical studies of cervical and lumbar surgeries in ASCs available at the time, the authors conclude that evidence for the safety and utility of multiple outpatient spine procedures is growing and providers, payers, hospitals and patients all stand to benefit if greater investments are made in ASCs for spine surgery.
Neurosurgery
Published: May 2017
Finding: Authors examined 3000+ ambulatory and 46,000+ inpatient elective anterior cervical discectomy and fusions (ACDFs) performed in CA, FL, and NY from 2009 to 2011. They found higher 30-day emergency room visits, and higher readmission/reoperation rates for the inpatient population. Overall charges were significantly lower in ambulatory settings ($33,362) than inpatient settings ($74,667).
GI Procedures
JAMA Internal Medicine
Published: December 2018
Finding: A negative colonoscopy result in average-risk patients was associated with a lower risk of colorectal cancer and related deaths for more than 12 years after examination, compared with unscreened patients. Our study findings may be able to inform guidelines for rescreening after a negative colonoscopy result and future studies to evaluate the costs and benefits of earlier vs later rescreening intervals.