Variation in ambulatory surgery utilization in Michigan.
Kyle H Sheetz1, Lauren Corona1, Shannon Cramm1
1Department of Surgery, University of Michigan, Ann Arbor, Michigan.
The Journal of Surgical Research
|March 27, 2014
Summary
Ambulatory surgery utilization varies widely among Michigan hospitals for general procedures. Surgeon-level factors, not patient or hospital characteristics, largely explain these differences, suggesting new quality improvement avenues.
Area of Science:
- Surgical Quality Improvement
- Health Services Research
Background:
- Ambulatory surgery has significantly expanded due to technological advancements and cost pressures.
- Characterizing ambulatory surgical practice for common general surgical procedures is crucial.
Purpose of the Study:
- To analyze the utilization of ambulatory surgery for general surgical procedures in Michigan.
- To identify factors influencing the variation in ambulatory surgery rates across hospitals.
Main Methods:
- Utilized data from 33,655 patients in the Michigan Surgery Quality Collaborative registry.
- Employed multilevel mixed-effects logistic regression to adjust for patient comorbidities, procedure mix, and hospital characteristics.
- Assessed postoperative complication rates across hospitals stratified by ambulatory surgery utilization.
Main Results:
- Ambulatory surgery utilization rates varied widely (29%-75%) across 34 hospitals, with a mean of 54%.
- Risk-adjusted complication rates were similar between high and low ambulatory surgery utilization hospitals (2.2% vs. 2.3%).
- Surgeon-level factors, not patient or hospital characteristics, were the primary drivers of utilization variability.
Conclusions:
- Significant variation exists in ambulatory surgery utilization for general surgery, unexplained by patient or hospital factors.
- Surgeon-level influences are key determinants of ambulatory surgery adoption.
- Understanding these surgeon-specific factors offers a novel pathway for quality improvement in surgical care.
