A database review showed ASCs began taking older, sicker patients between 2006 and 2010, General Surgery News reports.
Eric Rosero, MD, and Girish Joshi, MD, analyzed data from the 2006 National Survey of Ambulatory Surgery and the 2010 National Hospital Ambulatory Medical Care Survey. The study comprised 34,738,440 ASC visits in 2006 and 28,588,475 in 2010.
Here are seven findings:
1. There was a significant increase in the number of ASC patients with challenging medical conditions.
Challenging medical conditions were defined as being over 80 years old or diagnosed with any of the following conditions: pulmonary hypertension, obstructive sleep apnea, heart failure, cardiac arrhythmia, cardiac valve disease, chronic renal failure, diabetes mellitus, post-organ transplant, post-coronary angioplasty/stent or post-implantation of a heart assist device or a pacemaker/implantable cardioverter defibrillator.
2. The average age of ambulatory surgery patients increased from 52.2 to 53.7, a statistically significant difference. However, the proportion of octogenarians dropped from 9.5 percent in 2006 to 7.9 percent in 2010.
3. There was a statistically significant increase in patients with complex comorbidities:
- Obstructive sleep apnea: 0.32 percent to 0.45 percent
- Heart failure: 0.13 percent to 0.22 percent
- Pacemaker/AICD: 0.15 percent to 0.26 percent
- Cardiac arrhythmias: 0.24 percent to 0.55 percent
- Chronic renal failure: 0.52 percent to 0.76 percent
- Diabetes mellitus: 1.21 percent to 1.71 percent
4. The overall proportion of patients with challenging conditions rose from 12.8 percent to 13.9 percent, which was also statistically significant.
5. Pulmonary hypertension, post-organ transplant, valve disease and implantation of heart assist devices or coronary stents remained the same or decreased during the time period.
6. Dr. Rosero noted criteria for outpatient surgery selection have become less restrictive. "This analysis suggests that sicker patients are increasingly being offered outpatient surgery in this country," he said.
7. Researchers are now analyzing data from state databases for information about unplanned admissions and readmissions to determine whether ambulatory surgery is appropriate for patients with challenging conditions.
