Postoperative acute care use after freestanding ambulatory surgery

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• 作者：George Molina ; MD ; MPH^a ; ^b ; Bridget A. Neville ; MPH^a ; Stuart R. Lipsitz ; ScD^a ; Lorri Gibbons ; RN ; BSN ; CPHQ^c ; Ashley Kay Childers ; PhD ; CPHQ^c ; ^d ; Atul A. Gawande ; MD ; MPH^a ; William R. Berry ; MD ; MPP ; MPH^a ; Alex B. Haynes ; MD ; MPH^a ; ^b ; ^{abhaynes@mgh.harvard.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Freestanding ambulatory surgery centers ; Ambulatory surgery ; Postoperative acute care
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：205
• 期：2
• 页码：331-340
• 全文大小：264 K

文摘

Surgical procedures in the United States are increasingly performed in the ambulatory setting, including freestanding ambulatory surgery centers (ASCs). However, there is a lack of research and tracking of surgical outcomes in this setting.

Materials and methods

We analyzed data from a state all-payer claims database to produce a retrospective cohort study on the rate of acute care use (emergency department [ED] visits and inpatient admissions) within 7 d after operations performed in freestanding ASCs in South Carolina. Two-level reliability-adjusted generalized linear mixed models accounting for random facility-level effects were used to adjust for patient-level and facility-level characteristics.

Results

A total of 1,328,708 procedures were performed in 86 freestanding ASCs in South Carolina from 2006-2013. The overall rate of postoperative acute care per 1000 procedures within 7 d was 17.3 (95% confidence interval [CI], 15.3-19.5). Patient characteristics associated with the highest postoperative acute care use within 7 d included Medicaid insurance (adjusted odds ratio [aOR], 1.79; 95% CI, 1.70-1.90), lowest median household income (aOR, 1.36; 95% CI, 1.30-1.43), and preoperative Charlson Comorbidity Index (CCI) score 3+ (aOR, 4.14; 95% CI, 3.95-4.34). Total charges for postoperative ED visits (n = 14,682) and inpatient admissions (n = 8945) within 7 d were approximately $51.4 and $361.1 million, respectively from 2006-2013.

Conclusions

Acute care use within 7 d was commonly ≥10 per 1000 procedures performed in freestanding ASCs in South Carolina. These measures may be targets for quality and cost improvement and innovation. Patients at risk for acute care utilization may benefit from improvements in postoperative follow-up after procedures in ASCs.