Outpatient surgery, also known as ambulatory surgery, day surgery,
day case surgery, or same-day surgery, is
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
that does not require an overnight
hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
stay.
[The ]International Association for Ambulatory Surgery The International Association for Ambulatory Surgery
was formed in 1995 when Clinician, clinicians from several countries who were interested in Outpatient surgery, ambulatory surgery (otherwise known as day surgery) came together to form the organi ...
(IAAS) would not consider all of these terms synonymous. In a 2003 documen
"Ambulatory (day) surgery: suggested international terminology and definitions"
the IAAS recommends defining an "outpatient" procedure as one "carried out in the outpatient department of a hospital" and an "ambulatory" procedure as one "excluding an office/surgery or outpatient operation/procedure, where the patient is discharged on the same working day." That is, "ambulatory surgery" occurs in an "ambulatory surgery center." The term “
outpatient
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...
” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs.
[
Outpatient surgery may occur in an inpatient facility, in a self-contained unit within a hospital (also known as a hospital outpatient department), in a freestanding self-contained unit (also known as an ambulatory surgery center), or in a physician's office-based unit.][ Between the late 20th century and early 21st century, outpatient surgery has grown in popularity in many countries.][ In the United States, 65% of surgeries at hospitals in 2012 were conducted on an outpatient basis, compared with 54% in 1992.]
Studies have shown that outpatient surgery is as safe as or safer than inpatient surgery. For instance, complication rates and post-surgical hospitalization or readmission rates are comparable, and pain and infection rates are lower after outpatient surgery than inpatient surgery.[ Nevertheless, articles in the newsmedia (such as some discussing the 2014 death of ]Joan Rivers
Joan Alexandra Molinsky (June 8, 1933 – September 4, 2014), known professionally as Joan Rivers, was an American comedian, actress, producer, writer and television host. She was noted for her blunt, often controversial comedic persona—heavi ...
after an outpatient procedure) have questioned the safety of outpatient surgery performed at ambulatory surgery centers.
Ambulatory surgery centers
Ambulatory surgery centers, also known as outpatient surgery centers, same day surgery centers, or surgicenters, are health care facilities where surgical procedures not requiring an overnight hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
stay are performed. Such surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
is commonly less complicated than that requiring hospitalization
A hospital is a health care institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...
. Avoiding hospitalization can result in cost savings to the party responsible for paying for the patient's health care
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
.
These centers specialize in providing surgery, including certain pain management
Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals pr ...
and diagnostic
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engine ...
(e.g., eye muscle surgery services) in an outpatient
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...
setting. Overall, the services provided can be generally called procedures. These 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
As of 2011, physicians performed more than 23 million procedures per year in over 5,300 ASCs in the United States.
In the 1980s and 1990s, many procedures that used to be performed exclusively in hospitals began taking place in ASCs as well. Many knee, shoulder, eye, spine and other surgeries are currently performed in ASCs. As of 2016, of procedures in ASCs funded by Medicare in the United States, the three most common were cataract surgery
Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye (also called "crystalline lens") that has developed an opacification, which is referred to as a cataract, and its replacement with an intraocu ...
with intraocular lens
Intraocular lens (IOL) is a lens implanted in the eye as part of a treatment for cataracts or myopia. If the natural lens is left in the eye, the IOL is known as phakic, otherwise it is a pseudophakic, or false lens. Such a lens is typically i ...
insert (18.7% of all procedures), upper gastrointestinal endoscopy
Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considere ...
with biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...
(8.2%), and colonoscopy with biopsy (6.8%).
History
The first center in the USA was established in Phoenix, Arizona
Phoenix ( ; nv, Hoozdo; es, Fénix or , yuf-x-wal, Banyà:nyuwá) is the List of capitals in the United States, capital and List of cities and towns in Arizona#List of cities and towns, most populous city of the U.S. state of Arizona, with 1 ...
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. Five surgeons performed cases at the center on the first day it opened, and four of those procedures required general anesthesia.
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
Envision Healthcare is an American healthcare company and national hospital-based physician group.
History
In December 2016, Envison and AMSURG merged, and shortly thereafter the company's stock replaced Legg Mason in the S&P 500 index.
In 2 ...
, Tenet Healthcare
Tenet Healthcare Corporation is a for-profit multinational healthcare services company based in Dallas, Texas, United States. Through its brands, subsidiaries, joint ventures, and partnerships, including United Surgical Partners International (U ...
/United Surgical Partners International
United Surgical Partners International (USPI) is an American ambulatory care company based in Dallas, Texas. It was founded by Don Steen in 1998.
USPI currently is active in 28 states. USPI currently operates over 400 ambulatory facilities servin ...
, Surgical Care Affiliates
SCA Health (SCA), is one of the largest providers of outpatient surgery in the United States. Based in Deerfield, Illinois, the company has a network of 220 ambulatory surgery centers (ASCs) in 35 states performing 1 million procedures a year. ...
, Hospital Corporation of America
HCA Healthcare is an American for-profit operator of health care facilities that was founded in 1968. It is based in Nashville, Tennessee, and, as of May 2020, owns and operates 186 hospitals and approximately 2,000 sites of care, including sur ...
, Ambulatory Surgical Centers of America, and Surgery Partners and Physicians Endoscopy. Nearly 68 percent of ASC management companies reported having equity ownership in all freestanding entities they managed.
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. With only 1 Medicare Certified ASC, Vermont is at the bottom of the list.
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
The Ambulatory Surgery Center Association is a nonprofit association in the United States. It represents all aspects of the Ambulatory Surgery Center industry including the physicians, nurses, administrative staff and owners.
The association repre ...
(ASC Association), which was formed in 2008 when the Federated Ambulatory Surgery Association
The Ambulatory Surgery Center Association is a nonprofit association in the United States. It represents all aspects of the Ambulatory Surgery Center industry including the physicians, nurses, administrative staff and owners.
The association repre ...
(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.
Accreditation
Accreditation
Accreditation is the independent, third-party evaluation of a conformity assessment body (such as certification body, inspection body or laboratory) against recognised standards, conveying formal demonstration of its impartiality and competence to ...
organizations for ASCs provide standards of medical care, record keeping, and auditing. 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.
Effective in 1996, California was the first state in the United States to require accreditation for all outpatient surgery settings that administer anesthesia. The Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
have approved five organizations to accredit ASCs: Accreditation Association for Ambulatory Health Care
The Accreditation Association for Ambulatory Health Care (AAAHC), founded in 1979, is an American organization which accredits ambulatory health care organizations, including ambulatory surgery centers, office-based surgery centers, endoscopy cen ...
(AAAHC), American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Healthcare Facilities Accreditation Program
The Healthcare Facilities Accreditation Program (HFAP) is a not-for-profit organization meant to help healthcare organizations maintain their standards in patient care and comply with regulations and the healthcare environment. Headquartered in Chi ...
(HFAP), Institute for Medical Quality (IMQ), and The Joint Commission
The Joint Commission is a United States-based nonprofit tax-exempt 501(c) organization that accredits more than 22,000 US health care organizations and programs. The international branch accredits medical services from around the world. A majorit ...
(TJC).
See also
* National Association for Ambulatory Urgent Care
Notes
References
External links
Canadian Association for Accreditation of Ambulatory Surgical Facilities
International Association for Ambulatory Surgery
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program
Outpatient Surgery Magazine
{{Authority control
Surgery