The Safety of Performing Surgery at Ambulatory Surgery Centers Versus Hospital Outpatient Departments in Older Patients With or Without Multimorbidity

Silber, Jeffrey H.; Rosenbaum, Paul R.; Reiter, Joseph G; Jain, Siddharth; Ramadan, Omar I.; Hill, Alexander S.; Hashemi, Sean; Kelz, Rachel R.; Fleisher, Lee A.

doi:10.1097/mlr.0000000000001836

Cited by 2 publications

(3 citation statements)

References 38 publications

(54 reference statements)

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“…25 We also reported a secondary stability analysis that used a matched-cohort design. In the main analysis, patients were exactly matched on multimorbidity status 18,26 and the surgical procedure group; moreover, within procedure groups, individual procedure CPTs were exactly matched as often as possible (near-exact matching 27 ) (eTable 2 in Supplement 1). The match also controlled for demographic vari-ables, including age at the time of the procedure, sex, race, and socioeconomic status (including education, poverty, and dualeligibility indicators).…”

Section: Discussionmentioning

confidence: 99%

“…While not all ED visits or admissions within 7 days of surgery are necessarily directly related to the ASC procedure, it would be of interest if cases or controls had an elevated odds of such events, so we therefore defined ED visits with or without a subsequent admission as a revisit. In our previous published work on ASCs, we used this revisit definition as our primary outcome 18 and others have used revisits or ED visits for evaluating surgical outcomes. [19][20][21][22][23]…”

Section: Defining Patient Outcomesmentioning

confidence: 99%

“…We used our refined definition of multimorbidity 24 based on clusters of several comorbid conditions (qualifying comorbidity sets). Following Silber et al, 18 multimorbidity definitions used comorbid conditions recorded up to 3 years prior to surgery. By definition, a qualifying comorbidity set is associated with at least a doubling of the odds of death within 30 days of general or orthopedic surgery.…”

Section: Defining Multimorbiditymentioning

confidence: 99%

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Assessing the Ambulatory Surgery Center Volume-Outcome Association

Jain,

Rosenbaum,

Reiter

et al. 2024

JAMA Surg

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ImportanceIn surgical patients, it is well known that higher hospital procedure volume is associated with better outcomes. To our knowledge, this volume-outcome association has not been studied in ambulatory surgery centers (ASCs) in the US.ObjectiveTo determine if low-volume ASCs have a higher rate of revisits after surgery, particularly among patients with multimorbidity.Design, Setting, and ParticipantsThis matched case-control study used Medicare claims data and analyzed surgeries performed during 2018 and 2019 at ASCs. The study examined 2328 ASCs performing common ambulatory procedures and analyzed 4751 patients with a revisit within 7 days of surgery (defined to be either 1 of 4735 revisits or 1 of 16 deaths without a revisit). These cases were each closely matched to 5 control patients without revisits (23 755 controls). Data were analyzed from January 1, 2018, through December 31, 2019.Main Outcomes and MeasuresSeven-day revisit in patients (cases) compared with the matched patients without the outcome (controls) in ASCs with low volume (less than 50 procedures over 2 years) vs higher volume (50 or more procedures).ResultsPatients at a low-volume ASC had a higher odds of a 7-day revisit vs patients who had their surgery at a higher-volume ASC (odds ratio [OR], 1.21; 95% CI, 1.09-1.36; P = .001). The odds of revisit for patients with multimorbidity were higher at low-volume ASCs when compared with higher-volume ASCs (OR, 1.57; 95% CI, 1.27-1.94; P &lt; .001). Among patients with multimorbidity in low-volume ASCs, for those who underwent orthopedic procedures, the odds of revisit were 84% higher (OR, 1.84; 95% CI, 1.36-2.50; P &lt; .001) vs higher-volume centers, and for those who underwent general surgery or other procedures, the odds of revisit were 36% higher (OR, 1.36; 95% CI, 1.01-1.83; P = .05) vs a higher-volume center. The findings were not statistically significant for patients without multimorbidity.Conclusions and RelevanceIn this observational study, the surgical volume of an ASC was an important indicator of patient outcomes. Older patients with multimorbidity should discuss with their surgeon the optimal location of their care.

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Section: Discussionmentioning

confidence: 99%

Section: Defining Patient Outcomesmentioning

confidence: 99%

Section: Defining Multimorbiditymentioning

confidence: 99%

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Assessing the Ambulatory Surgery Center Volume-Outcome Association

Jain,

Rosenbaum,

Reiter

et al. 2024

JAMA Surg

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Anesthesia-Related Closed Claims in Free-Standing Ambulatory Surgery Centers

Pimentel,

Chung,

Ross

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: As higher acuity procedures continue to move from hospital-based operating rooms (HORs) to free-standing ambulatory surgery centers (ASCs), concerns for patient safety remain high. We conducted a contemporary, descriptive analysis of anesthesia-related liability closed claims to understand risks to patient safety in the free-standing ASC setting, compared to HORs. METHODS: Free-standing ASC and HOR closed claims between 2015 and 2022 from The Doctors Company that involved an anesthesia provider responsible for the claim were included. We compared the coded data of 212 free-standing ASC claims with 268 HOR claims in terms of severity of injury, major injuries, allegations, comorbidities, contributing factors, and financial value of the claim. RESULTS: Free-standing ASC claims accounted for almost half of all anesthesia-related cases (44%, 212 of 480). Claims with high severity of injury were less frequent in free-standing ASCs (22%) compared to HORs (34%; P = .004). The most common types of injuries in both free-standing ASCs and HORs were dental injury (17% vs 17%) and nerve damage (14% vs 11%). No difference in frequency was noted for types of injuries between claims from free-standing ASCs versus HORs––except that burns appeared more frequently in free-standing ASC claims than in HORs (6% vs 2%; P = .015). Claims with alleged improper management of anesthesia occurred less frequently among free-standing ASC claims than HOR claims (17% vs 29%; P = .01), as well as positioning-related injury (3% vs 8%; P = .025). No difference was seen in frequency of claims regarding alleged improper performance of anesthesia procedures between free-standing ASCs and HORs (25% vs 19%; P = .072). Technical performance of procedures (ie, intubation and nerve block) was the most common contributing factor among free-standing ASC (74%) and HOR (74%) claims. Free-standing ASC claims also had a higher frequency of communication issues between provider and patient/family versus HOR claims (20% vs 10%; P = .004). Most claims were not associated with major comorbidities; however, cardiovascular disease was less prevalent in free-standing ASC claims versus HOR claims (3% vs 11%; P = .002). The mean ± standard deviation total of expenses and payments was lower among free-standing ASC claims ($167,000 ± $295,000) than HOR claims ($332,000 ± $775,000; P = .002). CONCLUSIONS: This analysis of medical malpractice claims may indicate higher-than-expected patient and procedural complexity in free-standing ASCs, presenting patient safety concerns and opportunities for improvement. Ambulatory anesthesia practices should consider improving safety culture and communication with families while ensuring that providers have up-to-date training and resources to safely perform routine anesthesia procedures.

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The Safety of Performing Surgery at Ambulatory Surgery Centers Versus Hospital Outpatient Departments in Older Patients With or Without Multimorbidity

Cited by 2 publications

References 38 publications

Assessing the Ambulatory Surgery Center Volume-Outcome Association

Assessing the Ambulatory Surgery Center Volume-Outcome Association

Anesthesia-Related Closed Claims in Free-Standing Ambulatory Surgery Centers

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