Outcomes in ambulatory surgery

This review examines current economic and patient safety outcomes in ambulatory surgery. With the anticipated explosive growth of procedures performed in ambulatory surgery centers (ASCs) and office-based settings, this review is timely and relevant.

Ambulatory surgery volume continues to grow consistently, with 19.2 million ambulatory surgeries performed in US community hospitals in 2018. It is projected that between 2024 and 2034, ASC volume will rise 21% to 44 million procedures annually. The cost of performing the same procedure at an ASC or office-based setting is significantly lower compared to hospital outpatient departments with no difference in patient safety outcomes. Our profession is in the early stages of developing machine learning models, which will allow us to develop case-specific selection criteria and improve our ability to identify which patients can safely undergo more complex surgeries at ASCs.

As the complexity and diversity of patients, procedures, and facilities increase, it is increasingly evident that our prior universal selection criteria will need to be replaced with more nuanced criteria. It remains to be determined how the introduction of other technologies, such as outpatient wearable devices and remote monitoring, will impact the patient or procedural complexity that can be safely accommodated. Patient-reported outcome measures allow identification of minor adverse events, which are more common in the ambulatory setting.