Outpatient surgery
Encyclopedia
Outpatient surgery, also known as ambulatory surgery, same-day surgery or day surgery, is surgery
that does not require an overnight hospital
stay. The term “outpatient” arises from the fact that surgery patients may go home and do not need an overnight hospital bed. The purpose of outpatient surgery is to keep hospital costs down, as well as saving the patient time that would otherwise be wasted in the hospital.
Outpatient surgery has grown in popularity due to the rise in outpatient surgery centers and improved technology. Outpatient surgery centers often allow patients to get medical surgery and cosmetic surgery done in much more luxurious settings than a state hospital and are often preferred by patients for minor surgical procedures. Improved technology has also increased the frequency of outpatient surgery procedures. With shorter medical procedure
duration and fewer complications it makes sense to let patients go home sooner. About 65% of all surgical procedures are done on an outpatient basis.
Patients should check with their doctor for all information covering preparation for outpatient procedures. Complications related to surgery occur less than 1% of the time in outpatient settings. However, in terms of patient safety, non-hospital settings are not as regulated as hospitals are. Patients should inquire about all ambulatory clinics, surgical centers, and physicians' offices to make sure they meet state guideline
s.
where surgical procedures not requiring an overnight hospital
stay are performed. Such surgery
is commonly less complicated than that requiring hospitalization. Avoiding hospitalization can result in cost savings to the party responsible for paying for the patient's health care
.
An ASC, sometimes called surgicenter, specializes in providing surgery, including certain pain management
and diagnostic (e.g., colonoscopy
) services in an outpatient setting. Overall, the services provided can be generally called procedures. In simple terms, ASC-qualified procedures can be considered procedures that are more intensive than those done in the average doctor's office but not so intensive as to require a hospital stay. An ambulatory surgery center and a specialty hospital often provide similar facilities and support similar types of procedures. The specialty hospital may provide the same procedures or slightly more complex ones and the specialty hospital will often allow an overnight stay. ASCs do not routinely provide emergency services to patients who have not been admitted to the ASC for another procedure.
'Procedures' performed in ASCs are broad in scope. In the 1980s and 1990s, many procedures that used to be performed exclusively in hospitals began taking place in ambulatory surgery centers as well. Many knee, shoulder, eye, spine and other surgeries are currently performed in ASCs. In the United States today, more than 50% of Colonoscopy
services are performed in ambulatory surgery centers.
The first ASC was established in Phoenix, Arizona
in 1970 by two physicians who wanted to provide timely, convenient and comfortable surgical services to patients in their community, avoiding more impersonal venues like regular hospitals.
ASCs rarely have a single owner. Physicians partners who perform surgeries in the center will often own at least some part of the facility. Ownership percentages vary considerably, but most ASCs involve physician owners. Occasionally, an ASC is entirely physician-owned. However, it is most common for development/management companies to own a percentage of the center.
Some large healthcare companies own many types of medical facilities, including ambulatory surgery centers. The largest operator by revenue is Surgical Care Affiliates
, which is the former surgery division of HealthSouth Corporation, with 141 centers in 35 states. United Surgical Partners International
(USPI) manages 138 centers in the US, Hospital Corporation of America
manages 95. There are currently three publicly traded companies in the US who specialize in operating ASCs: NovaMed, AMSURG, and Symbion. There are also many privately held companies in the US who specialize in developing, managing and operating ASCs: Facility Development and Management.
In the United States
, more than 22 million surgeries a year are performed in more than 5,000 ASCs. ASCs are in all 50 states and can be found throughout the world. In the US, most ASCs are licensed, certified by Medicare
and accredited by one of the major health care accrediting organizations.
Although complications are very rare, ASCs are required by Medicare and the accreditation organizations to have a backup plan for transfer of patients to a hospital if the need arises.
The national nonprofit organizations that represents the interests of ASCs and their patients is Ambulatory Surgery Center Association (ASC Association), which was formed in 2008 when the Federated Ambulatory Surgery Association
(FASA) and the American Association of Ambulatory Surgery Centers (AAASC) merged.
Accreditation organizations are separate from the general trade organizations. Accreditation organizations for ASCs provide standards of medical care, record keeping, and auditing for ASCs. Some of the goals of these organizations include continuous improvement of medical care in surgery centers and providing an external organization where the public can get information on many aspects of ASCs. These accreditation organizations require members to receive periodic audits. These audits will come every one to three years, depending on the accreditation organization and the circumstances of the surgery center. In an audit, a team of auditors visits the facility and examines the ASC's medical records, written policies, and compliance with industry standards.
In 1996, California was the first state to require accreditation for all outpatient facilities that administer sedation or general anesthesia. Many other states have followed and require accreditation.
The three main accreditors of ASCs are American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC) and The Joint Commission.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
that does not require an overnight hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
stay. The term “outpatient” arises from the fact that surgery patients may go home and do not need an overnight hospital bed. The purpose of outpatient surgery is to keep hospital costs down, as well as saving the patient time that would otherwise be wasted in the hospital.
Outpatient surgery has grown in popularity due to the rise in outpatient surgery centers and improved technology. Outpatient surgery centers often allow patients to get medical surgery and cosmetic surgery done in much more luxurious settings than a state hospital and are often preferred by patients for minor surgical procedures. Improved technology has also increased the frequency of outpatient surgery procedures. With shorter medical procedure
Medical procedure
A medical procedure is a course of action intended to achieve a result in the care of persons with health problems.A medical procedure with the intention of determining, measuring or diagnosing a patient condition or parameter is also called a medical test...
duration and fewer complications it makes sense to let patients go home sooner. About 65% of all surgical procedures are done on an outpatient basis.
Patients should check with their doctor for all information covering preparation for outpatient procedures. Complications related to surgery occur less than 1% of the time in outpatient settings. However, in terms of patient safety, non-hospital settings are not as regulated as hospitals are. Patients should inquire about all ambulatory clinics, surgical centers, and physicians' offices to make sure they meet state guideline
Guideline
A guideline is a statement by which to determine a course of action. A guideline aims to streamline particular processes according to a set routine or sound practice. By definition, following a guideline is never mandatory. Guidelines are not binding and are not enforced. A guideline is a statement...
s.
Ambulatory surgery center
Ambulatory surgery centers (ASC), also known as outpatient surgery centers or same day surgery centers, are health care facilitiesHealth care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
where surgical procedures not requiring an overnight hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
stay are performed. Such surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
is commonly less complicated than that requiring hospitalization. Avoiding hospitalization can result in cost savings to the party responsible for paying for the patient's health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
.
An ASC, sometimes called surgicenter, specializes in providing surgery, including certain pain management
Pain management
Pain management is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists,...
and diagnostic (e.g., colonoscopy
Colonoscopy
Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
) services in an outpatient setting. Overall, the services provided can be generally called procedures. In simple terms, ASC-qualified procedures can be considered procedures that are more intensive than those done in the average doctor's office but not so intensive as to require a hospital stay. An ambulatory surgery center and a specialty hospital often provide similar facilities and support similar types of procedures. The specialty hospital may provide the same procedures or slightly more complex ones and the specialty hospital will often allow an overnight stay. ASCs do not routinely provide emergency services to patients who have not been admitted to the ASC for another procedure.
'Procedures' performed in ASCs are broad in scope. In the 1980s and 1990s, many procedures that used to be performed exclusively in hospitals began taking place in ambulatory surgery centers as well. Many knee, shoulder, eye, spine and other surgeries are currently performed in ASCs. In the United States today, more than 50% of Colonoscopy
Colonoscopy
Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
services are performed in ambulatory surgery centers.
The first ASC was established in Phoenix, Arizona
Phoenix, Arizona
Phoenix is the capital, and largest city, of the U.S. state of Arizona, as well as the sixth most populated city in the United States. Phoenix is home to 1,445,632 people according to the official 2010 U.S. Census Bureau data...
in 1970 by two physicians who wanted to provide timely, convenient and comfortable surgical services to patients in their community, avoiding more impersonal venues like regular hospitals.
ASCs rarely have a single owner. Physicians partners who perform surgeries in the center will often own at least some part of the facility. Ownership percentages vary considerably, but most ASCs involve physician owners. Occasionally, an ASC is entirely physician-owned. However, it is most common for development/management companies to own a percentage of the center.
Some large healthcare companies own many types of medical facilities, including ambulatory surgery centers. The largest operator by revenue is Surgical Care Affiliates
Surgical Care Affiliates
Surgical Care Affiliates, LLC, headquartered in Birmingham, Alabama operates a network of 150 ambulatory surgery centers and surgical hospitals across the country with approximately 3,700 full-time employees and more than 2,000 physician partners...
, which is the former surgery division of HealthSouth Corporation, with 141 centers in 35 states. United Surgical Partners International
United Surgical Partners International
United Surgical Partners International was founded in 1998, and is one of the prominent leaders in ambulatory surgery and short-stay medicine. 6,500 surgeons use USPI's facilities yearly vis-a-vis strategic parternship....
(USPI) manages 138 centers in the US, Hospital Corporation of America
Hospital Corporation of America
Hospital Corporation of America is the largest private operator of health care facilities in the world, It is based in Nashville, Tennessee and is widely considered to be the single largest factor in making that city a hotspot for healthcare enterprise.-History:The founders of HCA include Jack C....
manages 95. There are currently three publicly traded companies in the US who specialize in operating ASCs: NovaMed, AMSURG, and Symbion. There are also many privately held companies in the US who specialize in developing, managing and operating ASCs: Facility Development and Management.
In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, more than 22 million surgeries a year are performed in more than 5,000 ASCs. ASCs are in all 50 states and can be found throughout the world. In the US, most ASCs are licensed, certified by Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
and accredited by one of the major health care accrediting organizations.
Although complications are very rare, ASCs are required by Medicare and the accreditation organizations to have a backup plan for transfer of patients to a hospital if the need arises.
The national nonprofit organizations that represents the interests of ASCs and their patients is Ambulatory Surgery Center Association (ASC Association), which was formed in 2008 when the Federated Ambulatory Surgery Association
Federated Ambulatory Surgery Association
The Federated Ambulatory Surgery Association was a nonprofit association representing the interests of ambulatory surgery centers throughout the United States...
(FASA) and the American Association of Ambulatory Surgery Centers (AAASC) merged.
Accreditation organizations are separate from the general trade organizations. Accreditation organizations for ASCs provide standards of medical care, record keeping, and auditing for ASCs. Some of the goals of these organizations include continuous improvement of medical care in surgery centers and providing an external organization where the public can get information on many aspects of ASCs. These accreditation organizations require members to receive periodic audits. These audits will come every one to three years, depending on the accreditation organization and the circumstances of the surgery center. In an audit, a team of auditors visits the facility and examines the ASC's medical records, written policies, and compliance with industry standards.
In 1996, California was the first state to require accreditation for all outpatient facilities that administer sedation or general anesthesia. Many other states have followed and require accreditation.
The three main accreditors of ASCs are American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC) and The Joint Commission.
External links
- Outpatient Surgery Magazine
- Tips for outpatient surgery patients
- Accreditation Association for Ambulatory Health Care
- American Association for Accreditation of Ambulatory Surgery Facilities
- Joint Commission
- Canadian Association for Accreditation of Ambulatory Surgical Facilities
- Bariatric Surgery Center Network Accreditation Program
- International Association for Ambulatory Surgery