Ambulatory surgery centers (ASCs) are outpatient facilities that offer surgical procedures to patients at reduced costs, often with greater scheduling flexibility than hospitals. Also known as same-day surgery centers, these facilities allow patients to undergo minor surgical procedures during the day and recover at home rather than remain at a hospital for overnight observation.
While this model has advantages for patients seeking routine procedures, some reporting has suggested that ASCs pose unique safety risks. But how do those risks stack up against those incurred during inpatient procedures?
Are surgery centers safe?
A 2018 investigative report from Kaiser Health News, publicized by USA Today, revealed that more than 260 patients have died due to procedure complications at ASCs since 2013, primarily from “routine procedures” like tonsillectomies or colonoscopies. At least 10 percent of these patients died within 24 hours of being released from an ASC.
Most surgery center procedures are performed without any difficulty, and physicians have access to the proper training and specialized equipment. ASCs may not have the tools necessary in a medical emergency due to high medical device costs or lack of specialized training. According to the study, hospital providers are more likely than surgery center providers to have experience with trauma patients and emergency measures.
ASCs do not legally have the same staffing and emergency equipment requirements as hospitals, which the Kaiser investigative report suggested could lead to higher patient risk in life-threatening situations. In thousands of such cases, the Kaiser Health News discovered that ASC personnel had to call 911 for an emergency hospital transfer. Currently, Medicare requires surgery centers to align with a local hospital to transport patients in an emergency, but this could mean a 15-mile journey or longer in rural areas. Even in an urban setting, 30 minutes or more can pass between calling 911 and patient arrival at an emergency department—a potentially deadly delay.
The fast-paced nature of outpatient surgery might raise concerns that patients could be sent home too early without proper observation. Kaiser Health News cited several cases in which patients were found unresponsive upon arriving home, but these are rare events. Patients receiving surgery at an ASC should be cleared in advance by a medical team to present a low risk of complication for their intended procedure.
Are surgery centers as safe as hospitals?
Though surgery centers do not have the same equipment and training requirements as hospitals, they still must follow strict patient safety guidelines. According to the study, since 2015, Medicare health inspectors found more than 230 lapses in rescue equipment or training at ASCs across the U.S., with the potential to jeopardize patient health and safety.
But this does not mean that surgery centers are inherently less safe than hospitals. In fact, several studies have shown that ASCs are just as safe for patients as hospitals and other inpatient facilities, even for procedures like upper spine surgery. In fact, ASCs seem to have a lower risk of facility-acquired infection than hospitals.
Not all surgery centers in the U.S. are required to report to state or federal organizations. In New Jersey, for example, ASCs with only one operating room are not licensed by the state Department of Health, and therefore are not obligated to submit information on patient mortality or other events. These surgery centers are instead overseen by the licensing board for doctors.
The popularity of outpatient surgery centers with patients lies in their convenience and low costs, but physicians appreciate them for different reasons. Federal law allows physicians to refer patients to their own surgery centers, which offers much greater financial incentives than hospital referrals. Physicians who own surgery centers take a larger share of responsibility for patients, including risk assessment.
2019 OIG Report on ASCs
In September 2019, U.S. Department of Health and Human Services’ Office of Inspector General (OIG) released a data brief about ASCs, which found that infection control remains an issue at some ambulatory surgery centers. The report found that 77% of ASCs had at least one violation and 25% had serious deficiencies. The report also found that dozens of states didn’t meet survey requirements (many facilities went without any state survey for at least 6 years) or safety protocols, such as infection control or anesthesia administration. With ASCs now being approved for a growing number of complex surgeries, it’s increasingly important for ASCs to place emphasis on routine inspections and safety protocols.
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*Updated June 2022