More than half of surgeries are outpatient
■ Technical advances and financial pressures have contributed to changes in surgical procedures. Many now involve less than a 24-hour hospitalization.
For 57.7% of all surgeries performed in the hospital setting in 2007, patients did not have to stay overnight, according to a statistical brief issued Feb. 17 by the Agency for Healthcare Research and Quality. This is a significant increase in the 16% that were performed "same-day" in 1980, and included some procedures that surprised researchers.
For instance, 9.6% of open prostatectomies were outpatient, as were 13.8% of hysterectomies. In addition, 33.3% of mastectomies and 10.6% of spinal fusions were outpatient.
"We were really intrigued by the types of procedures that we were seeing. We really didn't expect to see some procedures being done on an outpatient basis at all," said Anne Elixhauser, PhD, one of the authors and a senior research scientist with AHRQ. "We're just seeing a real shift of procedures being done formerly in the inpatient setting that are now in the outpatient setting, and it's important to be aware of some of the procedures that we are going to likely see shift over time."
Some finding were expected. For example, colonoscopies were the most common outpatient procedure, accounting for 18.1% of the total. Upper gastrointestinal endoscopy and biopsy made up 10.8% of all outpatient procedures. In addition, 99.3% of eye surgeries and 96.3% of ear surgeries were outpatient.
These trends may be playing a role in the financial malaise that has affected many hospitals in this economic downturn, experts said. Many procedures that can be done on an outpatient basis also can be done outside of the hospital, such as in a medical practice.
"I do many, if not most, colonoscopies in an office-based endoscopy center," said Irving Pike, MD, a trustee with the American College of Gastroenterology, but speaking personally. "I expect we will see fewer in the hospital as we move forward."
Experts expect more surgeries to require less of a hospital stay because scientific advances such as improved anesthesia and minimally invasive surgical techniques make it possible to send patients home more quickly. In addition, outpatient services tend to be less costly, and the policies of third-party payers tend to favor ambulatory stays when possible. The mean charge for a hospital-based ambulatory surgical procedure was $6,100, including physician fees. The mean cost for an inpatient procedure was $39,900.