Since their introduction in 1970, having surgery at a same day surgical center has become increasingly common. During the 10-year period from 1996 to 2006, the frequency of surgery at same day surgical centers increased by 300%. The popularity of outpatient surgeries continue to rise, and today more than 50 million surgical procedures are performed in ambulatory surgery centers every year.
Given the frequency of surgery performed in outpatient surgery centers, it is important that patients considering surgery in an ambulatory surgical center evaluate the quality and safety standards of medical care that is being provided.
Differences Between Outpatient Surgery and Inpatient Surgery
Outpatient surgery centers, also known as ambulatory surgery centers or same day surgery centers, are surgical facilities where doctors perform “minor” surgical procedures that do not require an overnight hospital stay. These procedures are typically less complicated than those that require hospitalization and may include:
Operations on the nervous system, digestive system, or cardiovascular system
Coronary artery bypass surgery
Colonoscopies and colectomies (removing part of the colon to treat cancer)
Upper spine surgeries
Epidural steroid injections for pain management
Outpatient surgery, also known as same day surgery or ambulatory surgery, is simply a procedure that is performed with the expectation that the patient will be released to go home after the operation. Same day surgery has been made possible by advances in sedation and pain management, and the development of less-invasive surgical techniques.
After surgery in an outpatient surgical center, patients are released to a Post-Anesthesia Care Unit (PACU) for observation, and leave once they can drink, urinate, or perform other tasks as required by the surgeon.
Inpatient surgical procedures, by contrast, are those where the patient is expected to remain in the hospital following the procedure. After an in-patient surgical procedure, nurses and other hospital staff observe that patient, and are available to intervene if an emergency arises.
Benefits of Outpatient Surgery
Ambulatory surgery centers were introduced in the 1970s as a low-cost alternative to a hospital stay for minor, “routine” surgeries.
They are appealing because they offer affordable surgical care, greater scheduling flexibility, and minimal disruption to a patient’s life. Patients can recover in the comfort of their own home and do not need to stay overnight at a hospital for observation.
The popularity of outpatient surgery has grown as ambulatory surgical centers offer increasingly complex surgical procedures.
Yet, despite the popularity and convenience of having surgery at an outpatient facility, there are risks involved that are not present in a traditional hospital setting.
Risks of Surgery at an Ambulatory Surgical Center
While same day surgery centers offer convenience and financial savings, there are important details that make them different from having surgery in a hospital.
More than one-third of same day surgery centers employ doctors who are not board certified in their respective medical specialty.
Some outpatient surgical centers agree to treat high-risk patients who should only be operated on in hospitals.
Many same day surgery centers lack adequate safeguards to intervene in the event a problem occurs during surgery. In fact, nurses in same day surgery centers have had to call 9-1-1 for help when a surgical patient experienced complications during a medical procedures.
While Medicare requires that ambulatory surgical centers have an arrangement to transfer patients to a local hospital if a patient experiences complications during surgery, hospital treatment can be more than 30 minutes away, especially in rural areas.
Many outpatient surgical centers lack some of the lifesaving tools that might be available in a traditional hospital setting, and patients may be sent home too soon after a procedure without proper observation. Unlike hospitals, which are staffed 24 /7/ 365, outpatient surgical centers often keep normal business hours, which means patients, especially those who are seen at the end of the day, might not be monitored long enough to determine whether it is safe to discharge them.
Same day surgical centers fall short on compliance with hygiene standards and infection control, and have failed to comply with requirements regarding the responsible use of antibiotics. In September 2019, the U.S. Department of Health and Human Services' Office of Inspector General (OIG) released a report on ambulatory surgery centers which revealed that 77% of ambulatory surgery centers had at least one violation and 25% experienced serious deficiencies. The report also notes that many facilities do not meet safety protocols for infection control or anesthesia administration.
Patients Have Rights When Choosing a Surgery Provider
Any time a patient is considering a surgical procedure, it is important to remember that patients have the right to choose who will be performing the procedure.
If you or someone you care about is considering “routine” surgery at an ambulatory surgery center, understand that you can and should obtain information about the surgeon performing the procedure. You should know who the primary surgeon performing the procedure will be, and the physician’s credentials should be easily available. Your insurance company should have basic information about the surgeon on file, and you should have an understanding of the procedure that will be performed and what will happen if you experience complications during the procedure.
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