Outpatient surgery

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Outpatient surgery, also known as ambulatory surgery, same-day surgery, day case, or day surgery, is surgery that does not require an overnight hospital stay. The term “outpatient” arises from the fact that surgery patients may go home and do not need an overnight hospital bed. The purpose of outpatient surgery is to keep hospital costs down, as well as saving the patient time that would otherwise be wasted in the hospital.

Outpatient surgery has grown in popularity due to the rise in outpatient surgery centers and improved technology. Outpatient surgery centers often allow patients to get medical surgery and cosmetic surgery done in much more luxurious settings than a state hospital and are often preferred by patients for minor surgical procedures. Improved technology has also increased the frequency of outpatient surgery procedures. With shorter medical procedure duration and fewer complications it makes sense to let patients go home sooner. About 55% of all surgical procedures are done on an outpatient basis.[1]

Patients should check with their doctor for all information covering preparation for outpatient procedures. Complications related to surgery occur less than 1% of the time in outpatient settings.[2] However, in terms of patient safety, non-hospital settings are not as regulated as hospitals are. Patients should inquire about all ambulatory clinics, surgical centers, and physicians' offices to make sure they meet state guidelines.

Ambulatory surgery center[edit]

Ambulatory surgery centers (ASC), also known as outpatient surgery centers or same day surgery centers, are health care facilities where surgical procedures not requiring an overnight hospital stay are performed. Such surgery is commonly less complicated than that requiring hospitalization. Avoiding hospitalization can result in cost savings to the party responsible for paying for the patient's health care.[3]

An ASC, sometimes called surgicenter, specializes in providing surgery, including certain pain management and diagnostic (e.g., colonoscopy) services in an outpatient setting. Overall, the services provided can be generally called procedures. In simple terms, ASC-qualified procedures can be considered procedures that are more intensive than those done in the average doctor's office but not so intensive as to require a hospital stay. An ambulatory surgery center and a specialty hospital often provide similar facilities and support similar types of procedures. The specialty hospital may provide the same procedures or slightly more complex ones and the specialty hospital will often allow an overnight stay. ASCs do not routinely provide emergency services to patients who have not been admitted to the ASC for another procedure.

'Procedures' performed in ASCs are broad in scope. In the 1980s and 1990s, many procedures that used to be performed exclusively in hospitals began taking place in ambulatory surgery centers as well. Many knee, shoulder, eye, spine and other surgeries are currently performed in ASCs. In the United States today, more than 50% of Colonoscopy services are performed in ambulatory surgery centers.[4]

The 10 most common services ASCs provide are:

1. Cataract surgery w/ IOL insert: 17 percent

2. Upper GI endoscopy: 7.8 percent

3. Colonoscopy and biopsy: 6 percent

4. Diagnostic colonoscopy: 2.6 percent

5. After cataract laser surgery: 4 percent

6. Lesion removal colonoscopy: 4.6 percent

7. Injection spine: lumbar, sacral: 3.2 percent

8. Injection foramen epidural lumbar, sacral: 3.9 percent

9. Injection paravertebral: lumbar, sacral, add on: 3.4 percent

10. Injection paravertebral: lumbar, sacral: 2.4 percent[5]

The first ASC was established in Phoenix, Arizona in 1970 by two physicians who wanted to provide timely, convenient and comfortable surgical services to patients in their community, avoiding more impersonal venues like regular hospitals.[6] Five surgeons performed cases at the center on the first day it opened, and four of those procedures required general anesthesia.[7]

ASCs rarely have a single owner. Physicians partners who perform surgeries in the center will often own at least some part of the facility. Ownership percentages vary considerably, but most ASCs involve physician owners. Occasionally, an ASC is entirely physician-owned. However, it is most common for development/management companies to own a percentage of the center.

Some large healthcare companies own many types of medical facilities, including ambulatory surgery centers. The largest ASC chains in terms of numbers of centers include Envision Healthcare, Tenet Healthcare/United Surgical Partners International, Surgical Care Affiliates, Hospital Corporation of America, Ambulatory Surgical Centers of America, Surgery Partners and Physicians Endoscopy.[8] Nearly 68 percent of ASC management companies reported having equity ownership in all freestanding entities they managed.[9]

Each year, physicians perform more than 23 million procedures in ASCs in the 5,464 Medicare-certified ASCs. ASCs are in all 50 states and can be found throughout the world. In the US, most ASCs are licensed, certified by Medicare and accredited by one of the major health care accrediting organizations. California is the leading US state in the number of Medicare Certified ASCs, followed by Florida, and then Texas. California has 694 ASCs. It is followed by Florida with 387 ASCs and then Texas with 347 ASCs.[10] With only 1 Medicare Certified ASC, Vermont is at the bottom of the list.[11]

Although complications are very rare, ASCs are required by Medicare and the accreditation organizations to have a backup plan for transfer of patients to a hospital if the need arises.

The national nonprofit organizations that represents the interests of ASCs and their patients is Ambulatory Surgery Center Association (ASC Association), which was formed in 2008 when the Federated Ambulatory Surgery Association (FASA) and the American Association of Ambulatory Surgery Centers (AAASC) merged. William Prentice is the executive director of ASCA. He previously served as the director of the Washington office for the American Dental Association.[1]

Accreditation organizations are separate from the general trade organizations. Accreditation organizations for ASCs provide standards of medical care, record keeping, and auditing for ASCs. Some of the goals of these organizations include continuous improvement of medical care in surgery centers and providing an external organization where the public can get information on many aspects of ASCs. These accreditation organizations require members to receive periodic audits. These audits will come every one to three years, depending on the accreditation organization and the circumstances of the surgery center. In an audit, a team of auditors visits the facility and examines the ASC's medical records, written policies, and compliance with industry standards.

In 1996, California was the first state to require accreditation for all outpatient facilities that administer sedation or general anesthesia. Many other states have followed and require accreditation.

The three main accreditors of ASCs are the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC), and the Joint Commission.


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