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Observational Study
. 2015 Oct;50(5):1491-507.
doi: 10.1111/1475-6773.12278. Epub 2015 Jan 22.

Ambulatory Surgery Centers and Their Intended Effects on Outpatient Surgery

Brent K Hollenbeck  1 , Rodney L Dunn  2 , Anne M Suskind  3 , Seth A Strope  4 , Yun Zhang  2 , John M Hollingsworth  1
Affiliations
Observational Study

Ambulatory Surgery Centers and Their Intended Effects on Outpatient Surgery

Brent K Hollenbeck et al. Health Serv Res. 2015 Oct.

Abstract

Objectives: To assess the impact of ambulatory surgery centers (ASCs) on rates of hospital-based outpatient procedures and adverse events.

Data sources: Twenty percent national sample of Medicare beneficiaries.

Study design: A retrospective study of beneficiaries undergoing outpatient surgery between 2001 and 2010. Health care markets were sorted into three groups-those with ASCs, those without ASCs, and those where one opened for the first time. Generalized linear mixed models were used to assess the impact of ASC opening on rates of hospital-based outpatient surgery, perioperative mortality, and hospital admission.

Principal findings: Adjusted hospital-based outpatient surgery rates declined by 7 percent, or from 2,333 to 2,163 procedures per 10,000 beneficiaries, in markets where an ASC opened for the first time (p < .001 for test between slopes). Within these markets, procedure use at ASCs outpaced the decline observed in the hospital setting. Perioperative mortality and admission rates remained flat after ASC opening (both p > .4 for test between slopes).

Conclusions: The opening of an ASC in a Hospital Service Area resulted in a decline in hospital-based outpatient surgery without increasing mortality or admission. In markets where facilities opened, procedure growth at ASCs was greater than the decline in outpatient surgery use at their respective hospitals.

Keywords: Ambulatory surgery; ambulatory surgery center; utilization.

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Figures

Figure 1
Figure 1
Adjusted Rates of Hospital-Based Outpatient Surgery in Markets Where ASCs Were Always Present, Never Present, and in Those Where an ASC Opened for the First Time. In the period prior to baseline, the rate of change in outpatient surgery across the three market groups was similar (p = .22). However, for the 4-year period following baseline, rates of outpatient surgery decreased more rapidly in markets where an ASC was added for the first time (p < .001 for change over time relative to HSAs always with and without ASCs)
Figure 2
Figure 2
Adjusted Rates of Ophthalmologic (a), Gastrointestinal (b), and Musculoskeletal (c) Hospital-Based Outpatient Surgery in Markets Where ASCs Were Always Present, Never Present, and in Those Where an ASC Opened for the First Time. In the period after baseline, adjusted rates of hospital-based outpatient surgery declined more sharply in markets where an ASC opened for the first time compared to HSAs with and without ASCs (p < .01 for all three specialty groups)
Figure 3
Figure 3
Adjusted Thirty-Day Mortality Rates among Patients Undergoing Outpatient Surgery in Markets with ASCs, Those without and Those Where ASCs Were Added for the First Time. Rates of mortality were similar across HSA groups before (p = .84 for test between three slopes) and after (p = .43 for test between three slopes) baseline
Figure 4
Figure 4
Adjusted Thirty-Day Hospital Admission Rates among Patients Undergoing Outpatient Surgery in Markets with ASCs, Those without ASCs, and Those Where ASCs Were Added for the First Time. Rates of hospital admission were similar across HSA groups before (p = .43 for test between three slopes) and after (p = .56 for test between three slopes) baseline
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References

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