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Key Points
Define ambulatory surgery and the unique aspects of ambulatory surgery centers (ASCs).
Understand the history of ambulatory surgery and ASCs in the United States.
Review the most common procedures performed in ASCs compared to those performed in a hospital setting.
Discuss the financial benefits for patients and physicians within the structure of ASCs as they pertain to physician ownership, healthcare systems partnerships, and insurance reimbursement.
Understand the regulatory and accreditation processes that affect ASCs.
Predict how anticipated medical advances, technological development, and an aging population will affect the field of ambulatory surgery.
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Ambulatory Surgery is a multidisciplinary field in which surgical procedures are performed on patients who are not expected to be admitted to the hospital. The field includes procedures performed on patients in the setting of hospital outpatient departments (HOPDs), freestanding ambulatory surgery centers (ASCs), and those performed in doctor’s offices. The word ambulatory comes from the Latin ambulare, which means “to walk,” indicating that the patients arrived at the procedure on their own and departed after the procedure to their home environment.1
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Improved anesthesia techniques, the development of minimally invasive procedures, and changes to healthcare policy (particularly healthcare funding) have been the driving factors behind the increase in ambulatory surgery. Prior to these advances, almost all surgery was performed in an inpatient hospital setting. Any outpatient surgeries were minor, performed in physicians’ offices, and paid for by Medicare and insurers as part of the physician’s office visit reimbursement.2
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Since the early 1980s, the volume of ambulatory surgery has increased in the United States.2,3 Between 1981 and 2005, the number of outpatient surgeries nationwide grew almost 10-fold to over 32.0 million per year. Outpatient procedures grew from 19% to 60% of all surgical procedures, by volume, in the United States from 1981 to 2011.2,4,5 Strong financial incentives exist for hospitals to shift some surgeries to an outpatient setting. The number of Medicare-certified ASCs has also increased steadily, from fewer than 300 in the early 1980s2 to 5532 in 2016 (Fig. 52-1).5
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By definition, procedures at ASCs and physician’s offices are performed without the full resources of a hospital. The press has sensationalized a few adverse patient outcomes in these settings and made claims about the overall safety based on these isolated events. However, much of the convenience, high patient satisfaction rates, and cost-efficiency of ambulatory surgery is lost when performed in a hospital setting. Thus, the challenge underlying ambulatory surgery is performing safe operations on carefully selected patients in a manner that is patient-family–centric and economical.
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