Abstract：
BACKGROUND: There has been a recent push to transition procedures previously performed at hospital-based outpatient surgical departments (HOPDs) to ambulatory surgery centers (ASCs). However, limited data regarding differences in early postoperative complications and care utilization (eg, emergency department visits and unplanned admissions) may drive increased overall costs or worse outcomes.
OBJECTIVE: The purpose of this study was to examine differences in early 90-day adverse outcomes and postoperative emergency department visits associated with shoulder surgeries excluding arthroplasties that were performed in HOPDs and ASCs in a closed military health care system. We hypothesized that there would be no difference in outcomes between treatment settings.
METHODS: We retrospectively evaluated the records for 1748 elective shoulder surgeries from 2015 to 2020. Patients were considered as 1 of 2 cohorts depending on whether they underwent surgery in an ASC or HOPD setting. We evaluated groups for differences incomplexity, surgical time, and medical risk. Outcome measures were emergency department visits, unplanned hospital admissions, and complications within the first 90 days after surgery.
RESULTS: There was no difference in 90-day postoperative emergency department visits between procedures performed at HOPDs (n = 606) and ASCs (n = 1142). There was a slight increase in rate of unplanned hospital admission within 90 days after surgery in the HOPD cohort, most commonly for pain or overnight observation. The surgical time was significantly shorter (105 vs. 119 minutes, P < .01) at the ASC, but there was no difference in case complexity between the cohorts (P = .28).
CONCLUSIONS: Our results suggest that in appropriate patients, surgery in ASCs can be safely leveraged for its costs savings, efficiency, patient satisfaction, decreases in operative time, and potentially decreased resource utilization both during surgery and in the early postoperative period.
OBJECTIVE: The purpose of this study was to examine differences in early 90-day adverse outcomes and postoperative emergency department visits associated with shoulder surgeries excluding arthroplasties that were performed in HOPDs and ASCs in a closed military health care system. We hypothesized that there would be no difference in outcomes between treatment settings.
METHODS: We retrospectively evaluated the records for 1748 elective shoulder surgeries from 2015 to 2020. Patients were considered as 1 of 2 cohorts depending on whether they underwent surgery in an ASC or HOPD setting. We evaluated groups for differences incomplexity, surgical time, and medical risk. Outcome measures were emergency department visits, unplanned hospital admissions, and complications within the first 90 days after surgery.
RESULTS: There was no difference in 90-day postoperative emergency department visits between procedures performed at HOPDs (n = 606) and ASCs (n = 1142). There was a slight increase in rate of unplanned hospital admission within 90 days after surgery in the HOPD cohort, most commonly for pain or overnight observation. The surgical time was significantly shorter (105 vs. 119 minutes, P < .01) at the ASC, but there was no difference in case complexity between the cohorts (P = .28).
CONCLUSIONS: Our results suggest that in appropriate patients, surgery in ASCs can be safely leveraged for its costs savings, efficiency, patient satisfaction, decreases in operative time, and potentially decreased resource utilization both during surgery and in the early postoperative period.
摘要：
背景：最近一直在推动将以前在医院门诊外科（HOPD）进行的手术过渡到门诊手术中心（ASC）。然而,关于术后早期并发症和护理利用差异的数据有限(例如，急诊科就诊和计划外入院）可能会导致总体成本增加或结果更糟。
目的：/假设：本研究的目的是检查与肩关节手术相关的90天早期不良结局和术后急诊就诊的差异，排除在HOPD和ASC中在封闭式军事医疗系统中进行的关节置换术。我们假设治疗设置之间的结果没有差异。
方法：我们回顾性评估了2015年至2020年1,748例选择性肩关节手术的记录。根据患者是否在ASC或HOPD环境中接受手术，将患者视为两个队列之一。我们评估了不同群体的复杂性，手术时间,和医疗风险。结果措施是急诊就诊，计划外入院,以及术后前90天内的并发症。
结果：在HOPDs（n=606）和ASCs（n=1142）进行的术后90天急诊就诊没有差异。在HOPD队列中，手术后90天内计划外入院率略有增加，最常见的是疼痛或过夜观察。手术时间明显缩短（105vs119分钟，p<0.01)在ASC，但两组病例复杂性无差异(p=0.28).
结论：我们的结果表明，在适当的患者中，ASC中的手术可以安全地利用其成本节约，效率,患者满意度,手术时间减少，在术中和术后早期可能会降低资源利用率。
目的：/假设：本研究的目的是检查与肩关节手术相关的90天早期不良结局和术后急诊就诊的差异，排除在HOPD和ASC中在封闭式军事医疗系统中进行的关节置换术。我们假设治疗设置之间的结果没有差异。
方法：我们回顾性评估了2015年至2020年1,748例选择性肩关节手术的记录。根据患者是否在ASC或HOPD环境中接受手术，将患者视为两个队列之一。我们评估了不同群体的复杂性，手术时间,和医疗风险。结果措施是急诊就诊，计划外入院,以及术后前90天内的并发症。
结果：在HOPDs（n=606）和ASCs（n=1142）进行的术后90天急诊就诊没有差异。在HOPD队列中，手术后90天内计划外入院率略有增加，最常见的是疼痛或过夜观察。手术时间明显缩短（105vs119分钟，p<0.01)在ASC，但两组病例复杂性无差异(p=0.28).
结论：我们的结果表明，在适当的患者中，ASC中的手术可以安全地利用其成本节约，效率,患者满意度,手术时间减少，在术中和术后早期可能会降低资源利用率。
