Why the study?
Surgery for older Americans is increasingly performed at ambulatory surgery centers rather than hospital outpatient departments alongside rising multimorbidity, raising questions regarding differential outcomes.
Does performing surgery at ambulatory surgery centers compared to hospital outpatient departments reduce revisit and complication rates in older Medicare patients?
Does performing surgery at ambulatory surgery centers compared to hospital outpatient departments reduce revisit and complication rates in older Medicare patients?
Older Medicare patients undergoing surgery at ambulatory surgery centers have significantly lower 30-day revisit and complication rates compared to closely matched patients at hospital outpatient departments, likely reflecting appropriate patient selection by surgeons.
Answers are grounded in this paper and cite their sources.
ASC procedures linked to fewer revisits and complications than HOPD in matched older Medicare patients; leaves open whether selection effects or site of care explain differences.
BACKGROUND: Surgery for older Americans is increasingly being performed at ambulatory surgery centers (ASCs) rather than hospital outpatient departments (HOPDs), while rates of multimorbidity have increased. OBJECTIVE: To determine whether there are differential outcomes in older patients undergoing surgical procedures at ASCs versus HOPDs. RESEARCH DESIGN: Matched cohort study. SUBJECTS: Of Medicare patients, 30,958 were treated in 2018 and 2019 at an ASC undergoing herniorrhaphy, cholecystectomy, or open breast procedures, matched to similar HOPD patients, and another 32,702 matched pairs undergoing higher-risk procedures. MEASURES: Seven and 30-day revisit and complication rates. RESULTS: For the same procedures, HOPD patients displayed a higher baseline predicted risk of 30-day revisits than ASC patients (13.09% vs 8.47%, P < 0.0001), suggesting the presence of considerable selection on the part of surgeons. In matched Medicare patients with or without multimorbidity, we observed worse outcomes in HOPD patients: 30-day revisit rates were 8.1% in HOPD patients versus 6.2% in ASC patients ( P < 0.0001), and complication rates were 41.3% versus 28.8%, P < 0.0001. Similar patterns were also found for 7-day outcomes and in higher-risk procedures examined in a secondary analysis. Similar patterns were also observed when analyzing patients with and without multimorbidity separately. CONCLUSIONS: The rates of revisits and complications for ASC patients were far lower than for closely matched HOPD patients. The observed initial baseline risk in HOPD patients was much higher than the baseline risk for the same procedures performed at the ASC, suggesting that surgeons are appropriately selecting their riskier patients to be treated at the HOPD rather than the ASC.
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Silber et al. (2023) studied this question.
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