With outpatient procedures becoming increasingly commonplace, patients now have a variety of surgical settings available to them. Deciding between a surgical center and a hospital is an important decision, and determining which option is best warrants careful consideration. Surgery centers are freestanding facilities that provide same-day surgical care and may specialize in certain procedures. While they can resemble hospitals, these outpatient centers are smaller and often owned by physicians. Advances in anesthesia have increased the provision of ambulatory anesthesia services, subsequently expanding the range of procedures able to be safely performed in the outpatient setting. More surgeries are now being performed at surgery centers, and these facilities are becoming increasingly prevalent due the growing demand for lower-cost and higher quality care, clinical advances in technology, and financial incentives. The age, volume, and complexity of today’s outpatient surgical population has grown, enabling more patients to decide between different surgical settings [1].
Determining whether or not a patient case is appropriate for an ambulatory surgery setting is the first step in deciding between a hospital or surgery center. A key difference between the two facilities is that surgery centers, other than operating rooms and recovery bays, do not have the various support departments that hospitals do such as labs and ICUs. Because of this, concerns have emerged regarding the ability of these facilities to handle major problems in the peri-operative period. Should complications arise during a procedure at a surgery center, patients are often transferred to the nearest hospital facility, as hospitals have more resources to manage complications. Because not all patients are candidates for outpatient surgery, patient selection is critical to ensuring the safety of surgery centers. Key factors that affect the patient selection process include the procedure, personnel involved, surgical setting, and patient’s overall medical status. Anesthesia also has a pivotal role in the process, since key considerations for patient selection include the requirement of anesthesia and the type of anesthesia provider, whether it’s an anesthesiologist, a CRNA, or a surgeon and nurse [2]. Patients with cardiac disease, prolonged surgical time, obesity, and cerebrovascular disease are at higher risk during outpatient surgery and should consider a hospital setting [1]. A hospital is also generally more appropriate for frail older adults as they can take longer to heal and may be more likely to experience surgical complications and have stronger reactions to anesthesia [3].
Although hospitals are the preferred setting for higher risk surgical cases, there are many advantages to choosing a surgery center. Research has shown that the quality of surgery at a surgery center is superior if not equal to a hospital, and surgery center performance generally exceeds that of a hospital-based facility, specifically with regard to procedure efficiency [4]. Procedure delays and rescheduling are also less frequent in surgery centers since these facilities are able to exercise more control over the scheduling of procedures. There are significant financial benefits to choosing a surgery center as these facilities often cost 45-60% less than hospitals as a result of lower overhead, fixed costs, and the inability of patients to stay overnight. Surgery centers also experience lower surgical site infection rates than hospitals, however, rates are low in both surgical settings [5].
There are advantages and disadvantages to both hospitals and surgery centers, and studies have shown similar positive patient experiences in both settings [4]. Choosing between the two ultimately comes down to the individual circumstance, and not all patients are suitable for outpatient procedures. For patients who are eligible for outpatient surgery, surgery centers can offer a high quality, lower-cost alternative to hospitals. However, complicated cases and procedures that require greater recovery and observation times are better suited for hospitals.
References
[1] http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1918045
[2] http://www.sciencedirect.com/science/article/pii/S0094129813000291?via%3Dihub
[3] https://www.consumerreports.org/surgery/get-the-best-care-at-an-ambulatory-surgery-center/
[4] https://www.sciencedirect.com/science/article/pii/S0194599809014788
[5] https://www.beckershospitalreview.com/quality/ssi-rates-hospitals-vs-ascs-2010.html
[6] https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2013.1281
[7] https://www.advisory.com/daily-briefing/2014/09/16/are-surgery-clinics-less-safe-than-hospitals