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AMBULATORY SURGERY: 48 million procedures U.S. total

Effect of the Great Recession on utilization

Another reason that ambulatory surgery visit estimates could have decreased and ambulatory surgery procedures remained steady, could be the deep economic recession that began in 2007.  By 2010, when NHAMCS began gathering ambulatory surgery data in both hospitals and [ambulatory surgery centers], the economy had not fully recovered. (p. 5)

The U.S. National Center for Health Statistics provides nationally representative estimates of the utilization of hospital-based ambulatory surgery and non-hospital-affiliated ambulatory surgery centers.  These statistics are based on a sample survey that is taken occasionally, not every year.  Statistics have been published recently for 2010.

Why has ambulatory surgery increased over the years?

  • Improvements in anesthesia/analgesia
  • Development of minimally invasive techniques
  • Medicare reimbursement changes

How many ambulatory surgery procedures in 2010?

  • 25.7 million (53 percent) in hospitals
  • 22.5 million (47 percent) in independent ambulatory surgery centers
  • 48.3 million (100 percent) total ambulatory surgery procedures

Who pays?

  • The primary payer is private insurance (51 percent of visits)
  • Next is Medicare (31 percent)

How long are ambulatory surgery visits [duration]?

  • 57 minutes (average operating room time)
  • 33 minutes (surgical time)
  • 70 minutes (postop time)
  • There are more granular data showing the difference between hospitals and independent ASCs for this measure

Source: Hall, M.J., and others. (2017, February 28). Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. National Health Statistics Reports, 102.  Click here for free full text: https://www.cdc.gov/nchs/data/nhsr/nhsr102.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

MEDICARE: CMS fast facts provides US national statistics

This is a nice two-page summary of current statistics related to the Medicare and Medicaid programs. It provides official federal government counts of people and money – the number of beneficiaries and persons served and a recap of national health expenditures.  But WAIT!  There’s more!  I am excited to let you know of a count of the total number of providers by type in the U.S.  How many total hospitals?  How many hospitals of different types?  How many skilled nursing facilities?  Ambulatory surgery centers?  Labs?  And other types of providers.  These are useful totals for business planners who are sizing the market for a new product, for example.


U.S. Centers for Medicare & Medicaid Services. (2016, July 7). Fast Facts.  Click here for free full text: https://www.cms.gov/fastfacts/

For more indepth information: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


ROBOTICS: How many robotic surgery procedures per year?

This is an infographic with interesting tidbits about the dispersion of the da Vinci surgical robot – the market leader in robotic laparoscopic surgery.  Here is a look at the market (there are other vendors, but this is looking at the da Vinci):

  • One quarter of US hospitals have one or more da Vinci robots
  • 79 percent of procedures using a da Vinci robot are done in the US
  • 570,000 da Vinci robotic procedures worldwide in 2014
  • This is a 178 percent increase worldwide in 5 years
  • 450,000 da Vinci robotic procedures: US 2014
  • Here is a distribution of the types of da Vinci robotic procedures: 52 percent are gynecological; 24 percent are general surgery; 20 percent are urological; and 4 percent are other
  • Incremental cost per procedure using da Vinci ranges from $3,000 to $6,000.

Source: ECRI Institute. (2015). Robotic surgery: Arm yourself with the latest information on pricing, performance, clinical efficacy, and safety.  Click here for free full text:  https://www.ecri.org/Resources/ASG/Robotic_Surgery_Infographic_MS15369_web.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Unplanned Revisits Following Ambulatory Surgery

The outpatient counterpart for hospital inpatient readmissions is revisits. Even though two-thirds of surgeries  are done on an outpatient revisit, less quality of care data has been available for unplanned revisits following outpatient surgery than for unplanned readmissions after an inpatient operation. Here are some initial benchmarks from one research team that looked at ambulatory surgeries performed in hospital-owned settings that had low surgical risk:

  • All-cause revisits within 30 days of ambulatory surgery: 95 per 1000 operations
  • Most revisits were to emergency departments: 59 per 1000 operations
  • Revisits to inpatient surgery setting: 27 per 1000 operations
  • Two-thirds of the revisits [65 per 1000 operations] were for complications related to the procedure, while the remaining revisits were attributed to unrelated conditions.

The authors indicate more research is needed to determine which of the ambulatory surgery complication revisits may be preventable.


Steiner CA and others. Return to acute care following ambulatory surgery. JAMA 314(13):1397-1399, Oct. 6, 2015. http://jama.jamanetwork.com/article.aspx?articleid=2449176

AHRQ study: ambulatory ‘revisits’ occur frequently, often due to complications. AHRQ Electronic Newsletter, no. 497, Dec. 8, 2015, p. 3. http://content.govdelivery.com/accounts/USAHRQ/bulletins/129ba69

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

OPERATING ROOMS: Relative humidity below 30 percent raises concerns

In 2010, the American Society of Heating, Refrigeration and Air Conditioning Engineers (ASHRAE) changed its standard for relative humidity in the operating room.  The previous recommendation was for a range of 30 to 60 percent; the revision drops the lower range to 20 percent.  This position paper issued jointly by the American Hospital Association, the Health Industry Distributors Association, and the Association of periOperative Registered Nurses, among others, raises concerns about this change because of the sensitivity of certain electro-medical equipment to dry air conditions.  A series of questions that a hospital or ambulatory surgery center might use to analyze the issues related to dropping to 20 percent humidity are included.

Source: Relative humidity levels in the operating room: Joint communication to healthcare delivery organizations. (2015, Jan.). Retrieved from http://aorn.org/-/media/aorn/guidelines/position-statements/posstat-endorsed-relative-humidity-joint-communicaiton.pdf

Do ambulatory surgery centers affect hospital utilization?

Opening a freestanding ambulatory surgery center in a market where there previously had not been one decreased outpatient surgical volume at the local hospital by 7 percent, according to a large-scale study of Medicare beneficiaries.  The shift from hospital-based to ASC-based outpatient procedures was particularly pronounced for ophthalmology.  The researchers also analyzed the effect on quality of care and found no impact on either hospital admission within 30 days or on mortality rates due to the opening of an ambulatory surgery center.

Source: Hollenbeck, B.K., Dunn, R.L., Suskind, A.M., and others. (2015, Oct.). Ambulatory surgery centers and their intended effects on outpatient surgery. HSR. Health Services Research, 50(5), 1491-1507.  http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12278/abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Surgeries in Hospital-Owned Outpatient Facilities, 2012

Over half [53.1%] of all invasive, therapeutic surgeries performed on adults by hospitals were in an outpatient setting, according to a new report from the Agency for Healthcare Research and Quality.

Nearly all hospital-based surgeries related to the eye [98.8%] and ear [91.8%] were performed in an ambulatory care setting, while only 2.3% of obstetrical procedures were performed on an outpatient basis.

The report provides data on all categories of invasive, therapeutic surgeries performed on adults in community hospitals in 2012, based on an analysis of data from 28 states. The inpatient and outpatient volume, rate per 100,000 population, and percentage of surgeries that were performed in an ambulatory setting are provided for each type of procedure. Noninvasive surgeries and surgeries typically performed for diagnostic or exploratory purposes, such as colonoscopies, were excluded from the AHRQ analysis.


Source: Wier LM; Steiner CA; Owens PL. Surgeries in hospital-owned outpatient facilities, 2012. HCUP Statistical Brief [Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project], no. 188, Feb. 2015. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb188-Surgeries-Hospital-Outpatient-Facilities-2012.pdf

Related resource: Chart 3.11: Percentage share of inpatient vs. outpatient surgeries, 1993-2013. In: Trendwatch Chartbook 2015. American Hospital Association, Feb. 19, 2015. http://www.aha.org/research/reports/tw/chartbook/2015/chart3-11.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org