Data Interpretation: A Risky Business?

Data Interpretation: A Risky Business?

Those of you who read my blog are familiar with the issue I’m about to broach. I’d like to call your attention to an interesting study whose data no doubt detractors and supporters of ambulatory surgery can claim as their own, and then proceed to fight over. Researchers at the University of Pennsylvania School of Medicine have identified risk factors that may be associated with increased rates of hospital admission immediately following outpatient surgery. Those in the medical community already know that these risk factors are considered when deciding an appropriate surgical setting, whether outpatient or in a hospital. The study consisted of 783,558 ambulatory surgery patients, of which 4,351 were sent directly to a hospital following surgery, and of which 19 died. This equates to only one death per approximately 50,000 patients.

Medical risk factors were assigned point values. Increased scores in this risk index were associated with higher odds of hospital admission following outpatient surgery. Risk factors include being 65 years or older, operating time longer than 120 minutes, cardiac diagnoses, peripheral vascular disease, cerebro-vascular disease, malignancy, human immunodeficiency virus, and regional or general anesthesia.

Lee A. Fleisher, MD, FACC, FAHA, of the University of Pennsylvania Health System, and colleagues, who reported their findings in the Archives of Surgery, comments, “Most complications from outpatient surgery are minor. But if there is something major, would you rather be far away and need to call an ambulance and be transported varying distances to a hospital or would you rather have a full staff of physicians in the building and ready to help treat you?” Fleisher adds, “I believe outpatient surgery is very safe; however, as the practice gains in popularity, the risk factors for certain patients should be weighed. It is the responsibility of both the patient and the physician to consider the medical history and type of procedure before deciding what is best to ensure a healthy outcome.”

As an increasing number of complex procedures are being added to the ASC procedure list, it’s becoming clear that hospitals will be looking for any new ammunition they can use as they continue to wage war against ASCs. So a study on risk factors might be just the thing they need to sway healthcare consumers.

The press release announcing the study commented, “Surgery in freestanding surgery centers has many advantages, especially from a patient comfort standpoint. Close proximity to the surrounding community, more patient-friendly services, such as parking and in some cases a more procedure-specific focus are all plusses of the outpatient setting. However, ambulatory settings don’t have nearly the variety and expertise offered at a hospital, some say.” Which opened the door for Fleisher to note, “We know about 1 in 200 patients get admitted to hospitals following outpatient surgery, but that rate can easily vary. Outpatient surgery centers are going to continue pushing the envelope and it is imperative that patients and physicians take control back. We have some steps in place now that can help in the decision making process. We need to carefully review them and make sure we do what’s best for our patients regardless of the convenience factor.”

And our industry will continue to fight for what it knows to be the truth.

Until next month, 

Kelly M. Pyrek 
Group Editor, Medical Division 
kpyrek@vpico.com