Survey reveals hospital outpatient surgery decline

In a continuation of a trend of outpatient surgical procedures moving from hospitals to surgery centers and physician offices, hospitals reported a 1.1% decline in the percentage of outpatient surgeries performed at hospitals in 2003, the first drop in more than two decades, according to the latest annual survey from the American Hospital Association (AHA).

"In 1980, more than 90% of outpatient surgeries were performed in hospitals," says Caroline Steinberg, vice president for trends analysis for the AHA in Washington, DC. "By 2003, 47% were performed in hospital outpatient departments, 37% were in freestanding centers, and 16% were in physician offices."

Kathy Bryant, executive vice president of the Federated Ambulatory Surgery Association, says some large-volume procedures such as endoscopies and pain management may be moving to physician offices. "Physicians have long complained that they have difficulty scheduling these procedures in hospitals due to poor reimbursement," Bryant says.

The future movement of outpatient surgery is uncertain, Steinberg says. "Technology will continue to probably allow more patient surgeries to be provided in an outpatient setting," she says.

Bryant agrees. "As technology continues to improve, procedures will move to outpatient settings, and some projections suggest huge growth in surgical demand," she says. 

Where that surgery will be scheduled remains to be seen. "In some areas, we have heard of hospitals scheduling outpatient surgery at 10 p.m. due to limited capacity," Bryant says. "If outpatient operating rooms are full, then I would expect to see movement to other sites."