Where Is the Value in Ambulatory Versus Inpatient Surgery?

Abstract

Objective: The aim of this study was to estimate the effect of index surgical care setting on perioperative costs and readmission rates across 4 common elective general surgery procedures. Summary Background Data: Facility fees seem to be a driving force behind rising US healthcare costs, and inpatient-based fees are significantly higher than those associated with ambulatory services. Little is known about factors influencing where patients undergo elective surgery. Methods: All-payer claims data from the 2014 New York and Florida Healthcare Cost and Utilization Project were used to identify 73,724 individuals undergoing an index hernia repair, primary total or partial thyroidectomy, laparoscopic cholecystectomy, or laparoscopic appendectomy in either the inpatient or ambulatory care setting. Inverse probability of treatment weighting-adjusted gamma generalized linear and logistic regression was employed to compare costs and 30-day readmission between inpatient and ambulatory-based surgery, respectively. Results: Approximately 87% of index surgical cases were performed in the ambulatory setting. Adjusted mean index surgical costs were significantly lower among ambulatory versus inpatient cases for all 4 procedures (P < 0.001 for all). Adjusted odds of experiencing a 30-day readmission after thyroidectomy [odds ratio (OR) 0.70, 95% confidence interval (CI), 0.53–0.93; P = 0.03], hernia repair (OR 0.28, 95% CI, 0.20–0.40; P < 0.001), and laparoscopic cholecystectomy (OR 0.37, 95% CI, 0.32–0.43; P < 0.001) were lower in the ambulatory versus inpatient setting. Readmission rates among ambulatory versus inpatient-based laparoscopic appendectomy were comparable (OR 0.63, 95% CI, 0.31–1.26; P = 0.19). Conclusions: Ambulatory surgery offers significant costs savings and generally superior 30-day outcomes relative to inpatient-based care for appropriately selected patients across 4 common elective general surgery procedures.

Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis

“…In the study by Vons et al [8] that allowed patient discharge much earlier than the other trials, the duration of hospital stay in the group undergoing medical treatment alone was not statistically significantly shorter than that of patients undergoing appendectomy (3.96 days vs. 3.04 days, respectively, P = 0.08), although it did show that tendency. As ambulatory appendectomy has been shown to be feasible and safe in selected patients [40][41][42], it might be possible to reduce the duration of bed occupancy by proposing ambulatory appendectomy rather than management by antibiotic therapy alone.…”

The Rationale for Endoscopic Spinal Surgery

“…[14][15][16] Ultimately, in this context, health care economics are quickly pushing an increasing number of surgeons to adopt MISS techniques as they may enable the fastest recoveries. 15,17 It therefore appears inevitable that spinal endoscopy will continue to gain traction, particularly in the United States, as many of these techniques can be very readily performed in an outpatient setting. Moreover, with spinal endoscopy now being effectively performed without the routine use of general anesthesia, spinal endoscopy may indeed become the ideal outpatient spinal surgical technique.…”

“…Furthermore, outpatient spinal surgeries may be associated with superior short-term outcomes when compared to equivalent inpatient surgeries [ 14 - 16 ]. Ultimately, in this context, health care economics are quickly pushing an increasing number of surgeons to adopt MISS techniques as they may enable the fastest recoveries [ 15 , 17 ]. It therefore appears inevitable that spinal endoscopy will continue to gain traction, particularly in the United States, as many of these techniques can be very readily performed in an outpatient setting.…”

Crise sanitaire liée au COVID-19 : modalités du traitement de l’appendicite aiguë non compliquée de l’adulte par antibiothérapie seule comme alternative à l’appendicectomie

“…En effet, dans l'étude de Vons et al [8] qui autorisait la sortie la plus précoce par rapport aux autres essais, la durée d'hospitalisation dans le groupe du traitement médical exclusif n'était pas réduite comparativement aux patients appendicectomisés (3,96 jours vs 3,04 jours respectivement, p = 0,08). Dans la mesure où l'appendicectomie en ambulatoire chez des patients sélectionnés a montré sa faisabilité et sa sécurité [40][41][42], il est même alors possible que la durée d'occupation d'un lit d'hospitalisation puisse être réduite chez les patients pouvant être opérés en ambulatoire comparativement aux patients pris en charge par antibiothérapie seule. Bien que cette option n'ait jamais été évaluée directement, l'état d'urgence actuel conduit à faire une synthèse des données de la littérature autour de ce point.…”