30 years ago almost all orthopedic surgery was performed at a hospital.
Hospitals seem like the right choice for every kind of surgery. But this idea has been changing over the past few decades as "Surgery Centers" have become more popular.
What is the difference between surgery at a hospital and surgery at a surgery center?
A hospital is filled with doctors and nurses, medications and medical supplies in case complications occur during or after a surgery. A surgery center is also filled with doctors, nurses, medications and medical supplies in case a complication occurs. A surgery center is like the operating room detached from the rest of the hospital (no hospital beds). They are medical buildings on a much much smaller scale (they are often found in strip malls). The other difference is that patient's cannot spend the night at a surgery center. The most they are allowed to stay, by law, is 23 hours...once they spend a full 24 hours, the surgery center is now functioning as a hospital.
When is ok to perform Surgery outside of a hospital?
Hospitals are the default location for surgery.
But think about this: when a dentist pulls your wisdom teeth, he/she does not take you to the hospital for this "procedure", they do it right in the office (which has fewer doctors, nurses, medications, medical supplies if something goes wrong). People assume thats fine because its just a "procedure", but "Procedure" and "Surgery" are often used to describe the same thing. Pulling your wisdom teeth is really type of surgery - it involves a scalpel (read: knife), with risks of bleeding, air-way obstruction, and other concerns that are significant enough that a person needs to sign a Procedure Consent (waiver in case something goes wrong). So if Dentists are performing "procedures in their office", why not perform other procedures outside of the hospital?
Many of the standard orthopedic surgery procedures do very well at a surgery center, and its less expensive (84% cheaper on average), there is less paperwork and bureaucratic hassle and patients report higher satisfaction because they are in and out in a few hours as opposed to a few days.
The risks of complication for most orthopedic procedures is low and therefore patients do not need to spend the night in the hospital after surgery if they are able to be taken care of at home and their pain is well controlled.
What orthopedic procedures are performed at Surgery Centers?
Most Hand Surgery, like carpal tunnel release, trigger finger release, CMC arthroplasty, finger pinning.
Most foot and ankle surgery like repairs of broken ankles, bunion surgery.
Most sports surgery like rotator cuff repairs, meniscus repairs, ACL reconstructions. In the last decade rotator cuff repairs in surgery centers increased 250%, while those in hospitals decreased 65%.
Some Joint replacement surgery. This remains a controversial topic. Risk factors for readmission include: >65 years, ASA Physical Status II and III, BMI >25 kg/m2, diabetes mellitus, hypertension, smoking, chronic obstructive pulmonary disease, and longer surgical time.
Some spine surgery. Also controversial.
Medicare: Payment for Ambulatory Surgical Centers Should Be Based on the Hospital Outpatient Payment System [Internet]. Washington, DC 20548: United States Government Accountability Office; 2006 Nov. Report No.: GAO-07-86. http://http://www.gao.gov/products/GAO-07-86# Accessed September 20, 2016. 84% cheaper.
Robinson JC, Brown TT, Whaley C, Bozic KJ: Consumer choice between hospital-based and freestanding facilities for arthroscopy: Impact on prices, spending, and surgical complications. J Bone Joint Surg Am 2015;97(18):1473–1481.. Saves insurance companies about 17%.
Fortier J, Chung F, Su J: Unanticipated admission after ambulatory surgery: A prospective study. Can J Anaesth 1998;45(7):612–619. Unplanned admission around 1.5%. Many are preventable - 25% pain and 15% nausea/vomiting..huge amount were the ortho procedures: 60% of admissions for pain and >33% nausea/vomiting. risk factors: ASA Physical Status II or III and lengthier surgery were associated with overnight admissions: anesthesia duration >1 hour; surgery ending after 3 PM; and excessive postoperative pain, bleeding, nausea/vomiting, and drowsiness
Martín-Ferrero MÁ, Faour-Martín O, Simon-Perez C, Pérez-Herrero M, de Pedro-Moro JA: Ambulatory surgery in orthopedics: Experience of over 10,000 patients. J Orthop Sci 2014;19(2):332–338. 24-hour readmission was for pain, swelling, > 7 day postop were deep and superficial infections, suture dehiscence, intra-articular hematomas
De Oliveira GS Jr, Holl JL, Lindquist LA, Hackett NJ, Kim JY, McCarthy RJ: Older adults and unanticipated hospital admission within 30 days of ambulatory surgery: An analysis of 53,667 ambulatory surgical procedures. J Am Geriatr Soc 2015;63(8):1679–1685