A recent research letter in The Journal of the American Medical Association says that quality improvement and pay-for-performance initiatives in ambulatory surgery should use cause- or operation-specific outcomes, rather than all-cause outcomes. The researchers found that less than 15% of all-cause revisits by ambulatory surgery patients to inpatient or ambulatory surgery settings within 30 days involved clinically significant surgical site infections from ambulatory surgery. (Access the study at http://bit.ly/1Nqk5rl.)
The study looked at six procedures: laparoscopic cholecystectomy, incisional/abdominal hernia repair, anterior cruciate ligament repair, spine surgery, transurethral prostatectomy, and hysterectomy.
The ambulatory procedures were linked with 30-day postop unplanned acute care visits using the 2010-2011 Healthcare Cost and Utilization Project (HCUP) state ambulatory surgery and services databases, state inpatient databases, and state emergency department databases for seven states. The states were California, Florida, Georgia, Missouri, Nebraska, New York, and Tennessee. The data collected, which used unique, encrypted patient numbers, represented about one-third of the U.S. population.
The procedures were performed in hospital-owned settings: inpatient, ambulatory surgery, or emergency departments. The procedures were perofrmed on adults who were having one operation, with no infection, cancer, or acute care in the previous 30 days.
There were 482,034 ambulatory procedures, and there were 45,760 all-cause 30-day revisits (about 9.5% of all cases). Most revisits were to the emergency department, followed by inpatient facilities and ambulatory surgery settings. Revisit rates to the inpatient and emergency department settings were highest for transurethral prostatectomies and incisional/abdominal hernia repair.
For all operations and settings, up to one-third of all revisits were for unrelated conditions. Most inpatient and emergency department revisits were for complications related to the index operation. This pattern was seen across all six procedures.
“Considering the burden of revisits to patients and hospitals following ambulatory operations, our study highlights the importance of expanding health policy and clinical interventions to include ambulatory surgery and complications assessed in the ED,” the authors said. “Future work should determine associated risk factors and which complications are potentially preventable.”