Ambulatory Surgery

The volume of ambulatory surgery* continues to increase in the United States. Two-thirds of all surgical procedures performed in this country took place on an outpatient basis in 2006—10 years earlier, only 50% of surgeries were performed in the outpatient setting. A shift from hospital-based outpatient facilities to freestanding ambulatory surgery centers (ASCs) is also evident. From 2000 to 2006, the number of ASCs increased by 65% while the number of hospital ambulatory surgery departments declined by almost 6% (AHC Media). According to a report on ambulatory surgery released in 2009 by the Centers for Disease Control and Prevention (CDC), visits to ASCs increased threefold from 1996 to 2006; 43% percent of all outpatient procedures were performed in a freestanding ASC in 2006 (CDC). A high number of procedures are also performed on an outpatient basis in physician office settings. For example, of the 11.5 million surgical and nonsurgical cosmetic procedures performed in 2005, 48% took place in a physician office, says the American Society of Plastic Surgeons (Logan and Broughton).

_______________ * A number of different terms are used to denote surgery that is performed without an overnight stay in a healthcare facility, including outpatient surgery, ambulatory surgery, day surgery, and short-stay surgery. The term “ambulatory surgery” will be used in this Risk Analysis. _______________

These continuing trends in ambulatory surgery have implications for risk management, specifically with regard to the location of ambulatory surgery services but also in the key areas of patient safety and quality of care. In all settings, however, surgery that is performed on an outpatient basis requires that special attention be paid to the following issues:

In addition, risk managers must keep abreast of court decisions, regulatory actions, third-party payer incentives, advancements in surgery and anesthesia techniques, professional association standards and guidelines, and accreditation requirements affecting ambulatory care. This Risk Analysis focuses on ambulatory surgery that is hospital-based or ASC-based. See Office-Based Surgery and Anesthesia for more information about outpatient surgery and cosmetic procedures in the physician office.

Most acute care hospitals that provide surgical services began offering ambulatory surgery in the 1980s in response to reimbursement changes, technology advancements, the use of new surgical techniques, and patient demands. Although hospitals continue to perform most of the ambulatory surgeries, the rate of visits to hospitals for outpatient surgery has...