What is outpatient, or ambulatory surgery?

What is outpatient, or ambulatory surgery?

A few decades ago, the majority of surgeries were done in a hospital setting. A patient would show up to the hospital on the night before or day of their surgery and stay for at least two or three nights afterward. Called inpatient care, this was the widely accepted norm for many, many years.

Over the last thirty years, however, healthcare has shifted. Outpatient care—having a procedure or surgery that does not require an overnight stay in the hospital—has become increasingly popular.  Several things have contributed to the rise of outpatient surgery including improved surgical instruments, less invasive surgical techniques, and a desire to reduce the cost of healthcare.

The shift from inpatient care to outpatient care has been immense: over 50% of all surgical procedures are done on an outpatient basis. Below, you’ll learn where outpatient surgeries are performed, whether outpatient surgery is safe, and some of the benefits patients can expect.

Where is outpatient surgery done?

Outpatient surgery can be done in one of two facilities: at a hospital or at a standalone healthcare facility called an ambulatory surgery center, or ASC. When you receive care at a hospital as an outpatient, you are not admitted for an overnight stay but, instead, go home on the same day as your procedure.

Ambulatory surgery centers function in the same way, except that, unlike hospitals, they are not able to host patients overnight. They are able to do same-day surgeries, as well as diagnostic procedures such as MRIs. After having surgery at an ASC, you’ll spend up to a few hours in a recovery room before being sent home with instructions for post-procedure care. While you’re at the ASC, you’ll also schedule a follow-up appointment with your surgeon.

According to data from the Centers for Disease Control (CDC), in 2010, almost 26 million ambulatory surgery procedures were performed in hospitals, while nearly 23 million were performed in ASCs. This illustrates just how common outpatient procedures are today. It’s predicted that more and more surgeries will be done as outpatient procedures in the future, as a way to both eliminate the strain on hospitals and reduce the cost of healthcare for patients and the system.

Is outpatient surgery safe?

While the safety of outpatient surgery has been questioned, the reality is that, as with hospitals, the quality of ASCs varies. Carrum Health helps sift through the available options and picks only the highest quality ASCs.

In general, ASCs are just as safe as hospitals. One reason this is true across the board is that ambulatory surgery centers are held to many of the same regulations as hospital-based facilities. In fact, there’s an entire organization dedicated to ensuring that ASCs remain safe for patients: The Ambulatory Surgery Center Association (ASCA).

In some ways, outpatient surgery can be even safer than inpatient surgeries. For example, one recent study found that outpatient ankle fracture treatment leads to fewer complications, especially infections. The exact results vary by procedure.

Medicare certification and payment

In order to operate, every ASC must have, at a minimum, a state license. If an outpatient center wants to be paid by Medicare (which most do), they must comply with a set of strict federal regulations that govern everything from how the facility is designed to which surgical procedures are offered. Only when all of the guidelines are met will an ASC be paid by Medicare. They are also required to report data on eight quality measures in order to avoid having their Medicare payments reduced.

Accreditations for ASCs

Additionally, nearly every ambulatory surgery center wants to be part of a health insurance network. To do so, they need to become accredited by at least one of three organizations. Even if an ASC decides not to be in-network, they will often become accredited anyway. Each of the below organizations outlines intensive guidelines that must be met in order for an outpatient center to become certified:

Once an ASC becomes certified, they must participate in rigorous evaluations every year to maintain their accreditation.

Emergency preparedness

Outpatient safety doesn’t stop there, though. All ASCs must develop and maintain an emergency preparedness plan that includes:

  • Risk assessment and planning
  • Policies and procedures
  • Communication plan
  • Training and testing

While outpatient surgery centers can provide minor emergency care, they’re generally not equipped to deal with life-threatening complications. If such an emergency arises, you’ll be transferred to a nearby hospital. However, it’s important to note that ASC to hospital transfers are relatively uncommon.

Even in traditionally inpatient-only procedures like total hip replacements, studies have found that performing them as outpatient surgeries are safe. One such study, Is Outpatient Total Hip Arthroplasty Safe?, published in the May 2017 edition of The Journal of Arthroplasty, found that “patients undergoing outpatient THA were not at greater risk of 30-day adverse events or readmission than those that were performed as inpatient procedures.”

Which surgeries can be performed in an outpatient setting?

Procedure % performed as outpatient
Gastric Bypass Weight-Loss 99%
Meniscus removal 98%
Bunion repair 98%
Arthroscopy 98%
Peripheral nerve decompression 95%
Joint structure division 82%
Other musculoskeletal procedures, excluding hip/knee replacement, amputations and spinal fusion 73%
Joint replacement other than hip/knee 56%
Partial excision bone 44%
Fracture treatment 40%
Spinal decompression 30%

(Chart represents 70% of musculoskeletal and spinal procedures in the 2013 HCUP National Inpatient and State Ambulatory Surgery Dataset.)

What are the benefits of outpatient surgery?

Ambulatory surgery is generally safe, as long as ASCs follow accepted practices, such as those outlined by the ASC Quality Collaboration. It’s expected that safety will only continue to improve as the use of ASCs becomes even more common. Aside from knowing that having surgery as an outpatient is just as safe (if not safer) than having it as an inpatient, there are benefits to both you as a patient, and the healthcare system as a whole.  

More convenient care

Taking time off from your life to get surgery can be frustrating. Inpatient procedures require at least one night in the hospital, though it can be as long as a week for some patients and some surgeries. As an outpatient, you can return home on the same day as your surgery. While you’ll still have to spend time recovering, not having to spend three days in the hospital is a big win.

Shorter procedure times

The CDC found that the average time in the operating room for ambulatory surgery was 57 minutes. About half of this time was spent in surgery. Post-surgery care averaged 70 minutes. Interestingly, the total time spent in the operating room during surgery and receiving post-surgery care was significantly shorter in ASCs than in hospitals. This can largely be attributed to an increase in less invasive surgical techniques. Of course, the time spent in surgery and post-surgery care will vary, depending on the type of surgery, as well as your health. Another benefit to having your surgery done in an ASC is that you’re less likely to develop an infection than if you are at a hospital.

Increased affordability

It’s no secret that healthcare can be prohibitively expensive for many Americans. Thankfully, having your surgery done at an outpatient center is a much more affordable option than having it done as an inpatient procedure. When you use your Carrum Health surgery benefit, you don’t pay anything out-of-pocket but it’s still good to know that ASCs are a more cost-effective alternative for your employer. Going to an ASC can help keep your and your co-workers’ premiums from rising too quickly.

Reduced stress

The stress that comes with having surgery in a hospital can be high. Not only do you have to take time off work, you also have to navigate the challenges of daily life and familial obligations on top of preparing for, having, and recovering from surgery. Because outpatient surgery allows you to have the entire procedure complete in one day, much of that stress is eliminated. You’ll still need to attend a post-operation appointment, typically within 4 to 7 days. If you’re having your procedure done locally, you’ll be able to go home between appointments. It’s recommended for patients to have a travel companion and, if you’re traveling for your procedure, get out of the car and walk around on your trip home.

When you use your Carrum Health surgery benefit, your Carrum Concierge will help you determine whether you’re a candidate for outpatient surgery. If you’re interested, register and explore the outpatient surgeries we offer.