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Risks of outpatient surgery vary with patient characteristics, surgical setting

CHICAGO The likelihood of an elderly patient being admitted to a hospital within seven days, or dying shortly after undergoing surgery in an outpatient setting depends on health-related characteristics of the patient, and where the surgery was performed, according to an article in the January issue of The Archives of Surgery, one of the JAMA/Archives journals.

According to the article, it is estimated that approximately 60 percent to 70 percent of all surgical procedures are now performed in an outpatient setting (for example, a physician's office or specialized surgery center), and more and more high-risk patients, including the elderly, are having outpatient surgeries.

Lee A. Fleisher, M.D., who conducted his research while at The Johns Hopkins University, Baltimore, and colleagues examined the risk associated with 16 different surgical procedures among elderly (older than 65 years) Medicare beneficiaries from 1994 through 1999. Dr. Fleisher is now at the University of Pennsylvania School of Medicine, Philadelphia. (The procedures included cataract removal, prostate resection, hernia repair, laparoscopic gall bladder removal, dilation and curettage, vaginal hysterectomy, simple and modified mastectomy, hemorrhoidectomy, arteriovenous graft placement, knee arthroscopy, rotator cuff surgery).

The researchers studied 564,267 outpatient surgical procedures of which 360,780 were performed at a hospital-based outpatient center, 175,288 were performed at freestanding ambulatory surgery centers (ASCs), and 28,199 were performed in a physician's office.

There were no deaths on the day of surgery at a physician's office, four deaths the day of surgery at an ASC (2.3 per 100,000 procedures), and 9 deaths on the day of surgery at an outpatient hospital (2.5 per 100,000 procedures). The seven-day death rate was 35 per 100,000 outpatient procedures at a physician's office; 25 per 100,000 procedures at an ASC; and 50 per 100,000 procedures
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Contact: Jen Miller
215-349-5657
JAMA and Archives Journals
12-Jan-2004


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