Outpatient surgery

Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery, or same-day surgery, is surgery that does not require an overnight hospital stay. The term “outpatient” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs.:24-26 Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery, or same-day surgery, is surgery that does not require an overnight hospital stay. The term “outpatient” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs.:24-26 Outpatient surgery may occur in an inpatient facility, in a self-contained unit within a hospital (also known as a hospital outpatient department), in a freestanding self-contained unit (also known as an ambulatory surgery center), or in a physician's office-based unit.:61 Between the late 20th century and early 21st century, outpatient surgery has grown in popularity in many countries.:22 In the United States, 65% of surgeries at hospitals in 2012 were conducted on an outpatient basis, compared with 54% in 1992. Studies have shown that outpatient surgery is as safe as or safer than inpatient surgery. For instance, complication rates and post-surgical hospitalization or readmission rates are comparable, and pain and infection rates are lower after outpatient surgery than inpatient surgery.:24 Nevertheless, articles in the newsmedia (such as some discussing the 2014 death of Joan Rivers after an outpatient procedure) have questioned the safety of outpatient surgery performed at ambulatory surgery centers. Ambulatory surgery centers (ASC), also known as outpatient surgery centers, same day surgery centers, or surgicenters, 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. An ASC 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. As of 2011, physicians performed more than 23 million procedures per year in over 5,300 ASCs in the United States. 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 ASCs as well. Many knee, shoulder, eye, spine and other surgeries are currently performed in ASCs. As of 2016, of procedures in ASCs funded by Medicare in the United States, the three most common were cataract surgery with intraocular lens insert (18.7% of all procedures), upper gastrointestinal endoscopy with biopsy (8.2%), and colonoscopy with biopsy (6.8%). 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. Five surgeons performed cases at the center on the first day it opened, and four of those procedures required general anesthesia.