Do Surgical Times and Efficiency Differ Between Inpatient and Ambulatory Surgery Centers That are Both Hospital Owned?

Kadhim, Muayad; Gans, Itai; Baldwin, Keith; Flynn, John M.; Ganley, Theodore J.

doi:10.1097/bpo.0000000000000454

Cited by 47 publications

(28 citation statements)

References 9 publications

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“…Although surgeries performed at ASCs are reimbursed at a lower rate than those performed at HOPDs, ASCs maintain their financial solvency through greater efficiency and patient throughput and lower turnover times, resulting in increased surgical volume. 3,23 This is particularly beneficial for relatively quick surgeries like cataract extraction; many surgeries can be performed on a given day at a single ASC. Ambulatory surgery centers are more convenient than HOPDs for many patients because they are often closer to patients' homes.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Reasons for the increasing popularity of ASCs relative to HOPDs include enhanced surgeon productivity, improved convenience for patients and surgeons, decreased out-of-pocket patient costs, and decreased per-case costs for insurers. [3][4][5] An advantage of performing surgeries at HOPDs rather than ASCs is that when HOPDs are attached to hospitals, they are often better equipped to deal with medical emergencies. 6 To curtail rising surgical care costs, some insurers have considered incentivizing patients to undergo surgery at ASCs rather than HOPDs.…”

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confidence: 99%

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Trends in Use of Ambulatory Surgery Centers for Cataract Surgery in the United States, 2001-2014

et al. 2018

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IMPORTANCE Cataract surgery is commonly performed at ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). These venues differ in many ways, including surgical efficiency, patient throughput, patient safety, and costs per surgery. OBJECTIVE To determine trends in use of ASCs and HOPDs for cataract surgery from 2001 to 2014 and factors affecting the site of surgery. DESIGN, SETTING, AND PARTICIPANTS This retrospective longitudinal cohort analysis involved individuals 40 years and older who underwent cataract surgery between January 2001 and December 2014 from a nationwide US managed care network. Data were analyzed from February 2016 to February 2017. MAIN OUTCOMES AND MEASURES We identified all enrollees who underwent cataract surgery and determined whether the surgery was performed at an ASC or HOPD. We calculated the proportion of surgeries performed at each site each year from 2001 to 2014. Multivariable logistic regression identified characteristics of enrollees who had cataract surgery at an ASC vs a HOPD. We also assessed geographic variation in the proportion of cataract surgeries performed at ASCs in 306 communities throughout the United States. RESULTS Of the 369 320 enrollees included in this study, 208 319 (56.4%) were female, and the mean (SD) age was 66.3 (10.4) years. All enrollees underwent cataract surgery (531 325 surgeries) from 2001 to 2014. Of these, 237 046 (64.2%) underwent cataract surgery at an ASC. The proportion of cataract surgeries performed at ASCs increased from 43.6% in 2001 to 73.0% in 2014. Compared with enrollees with incomes less than $40 000, those with incomes greater than $100 000 were 20% more likely to undergo cataract surgery at an ASC (odds ratio, 1.20; 95% CI, 1.12-1.29). Enrollees with better overall health were no more likely to undergo cataract surgery at an ASC (odds ratio, 1.00; 95% CI, 0.99-1.00) than at an HOPD. Enrollees who lived in communities without certificate of need laws were more than twice as likely to have surgery at an ASC (odds ratio, 2.49; 95% CI, 2.35-2.63). The proportion of cataract surgeries performed at ASCs from 2012 to 2014 varied considerably, from 1.6% in La Crosse, Wisconsin, to 98.8% in Pueblo, Colorado. CONCLUSIONS AND RELEVANCE We observed a large shift in the site of cataract surgery from HOPDs to ASCs from 2001 to 2014. Future research is needed to assess the effect of this transition in site of surgical care on patient access to surgery, surgical outcomes, patient safety, and societal costs.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Trends in Use of Ambulatory Surgery Centers for Cataract Surgery in the United States, 2001-2014

et al. 2018

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“…In this prior study, the efficiency of a hospital inpatient facility was found to be inferior to that of its own ASC. 43 Orthopedic procedures by the same surgeon were performed more efficiently and more rapidly at the ASC than the inpatient facility. In this reported scenario, both the inpatient and ambulatory facilities were owned and operated by the same hospital without financial incentive to the operating surgeon.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficiency of Cervical Disc Arthroplasty in Ambulatory Surgery Centers vs. Hospital Settings

Gornet

Buttermann²,

Wohns

et al. 2018

Int J Spine Surg

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Background: Outpatient surgery has been shown safe and effective for anterior cervical discectomy and fusion (ACDF), and more recently, for 1-level cervical disc arthroplasty (CDA). The purpose of this analysis is to compare the safety and efficiency of 1-level and 2-level CDA performed in an ambulatory surgery center (ASC) and in a hospital setting.Methods: The study was a retrospective collection and analysis of data from consecutive CDA patients treated in ASCs compared to a historical control group of patients treated in hospital settings who were classified as outpatient (0 or 1-night stay) or inpatient (2 or more nights). Surgery time, blood loss, return to work, adverse events (AEs), and subsequent surgeries were compared.Results: The sample consisted of 145 ASC patients, 348 hospital outpatients, and 65 hospital inpatients. A greater proportion of 2-level surgeries were performed in hospital than ASC. Surgery times were significantly shorter in ASCs than outpatient or inpatient 1-level (63.6 6 21.6, 86.5 6 35.8, and 116.7 6 48.4 minutes, respectively) and 2-level (92.4 6 37.3, 126.7 6 43.8, and 140.3 6 54.5 minutes, respectively) surgeries. Estimated blood loss was also significantly less in ASC than outpatient and inpatient 1-level (18.5 6 30.6, 43.7 6 35.9, and 85.7 6 98.0 mL, respectively) and 2-level (21.1 6 12.3, 67.8 6 94.9, and 64.9 6 66.1 mL). There were no hospital admissions and no subsequent surgeries among ASC patients. ASC patients had 1 AE (0.7%) and hospital patients had 10 AEs (2.4%). Working patients returned to work after a similar number of days off, but fewer ASC patients had returned to work by the end of the 90-day period.Conclusions: Both 1-and 2-level CDA may be performed safely in an ASC. Surgeries in ASCs are of shorter duration and performed with less blood loss without increased AEs. Cervical Spine

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“…An effort to minimize resource utilization and improve surgical efficiency not only requires optimization of existing protocols, but also innovation of medical practice through implementation of telemedicine services and transition to same-day surgery, where patients are discharged on the day of surgery. [8] Previous studies have demonstrated the safety and efficacy of same-day mastectomy and breast reconstruction, largely relying on extensive perioperative planning and postoperative recovery protocols to simplify surgical course and minimize patient morbidity [9][10][11]. Prior implementation of an enhanced recovery protocol at our institution has decreased the need for opioid analgesia and length of hospital stay following mastectomy and implant-based breast reconstruction, thereby limiting the need for inpatient admission during the immediate postoperative period [12].…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

Specht

Sobti

Rosado

et al. 2020

Breast Cancer Res Treat

114

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Purpose As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis. Methods IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized. Results Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed. Conclusion This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implantbased breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.

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Do Surgical Times and Efficiency Differ Between Inpatient and Ambulatory Surgery Centers That are Both Hospital Owned?

Abstract: Level III.

Cited by 47 publications

References 9 publications

Trends in Use of Ambulatory Surgery Centers for Cataract Surgery in the United States, 2001-2014

Trends in Use of Ambulatory Surgery Centers for Cataract Surgery in the United States, 2001-2014

Safety and Efficiency of Cervical Disc Arthroplasty in Ambulatory Surgery Centers vs. Hospital Settings

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

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