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 guidelines.
Ambulatory surgery centers (ASC), also known as outpatient surgery centers or same day surgery centers, are health care facilities 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.[1]
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.