Title: An evaluation of patient risk factors to determine eligibility to undergo orthopaedic surgery in a freestanding ambulatory center: a survey of 4,242 consecutive patients
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Abstract Introduction: The value proposition of surgery at freestanding ambulatory surgery centers (FSASCs) in terms of efficiency, safety, and patient satisfaction is well established and has led to increased FSASC utilization. However, there are comorbid conditions that disqualify certain patients from surgery at FSASCs. Understanding the percentage of patients whose comorbid conditions exclude them from FSASCs is important for the proper planning and utilization of operating room assets. We aim to understand the percentage of excluded patients, and we predict that certain procedures have higher rates of disqualification due to the types of patients who undergo them. Methods: We reviewed the records of 4,242 consecutive patients undergoing outpatient orthopaedic surgeries in our hospital system from July 2015 to February 2016. Patient characteristics, comorbidities, and procedures performed were included in our database. We analyzed each case and determined eligibility for surgery at our FSASC based on established comorbidity exclusionary guidelines. Chi-square and t-tests were used to establish statistical significance. Results: Of 4,242 patients, 878 (20.7%) were ineligible for surgery at our FSASC based on accepted exclusionary guidelines. The average body mass index (BMI) of FSASC-eligible patients was 27.37, compared to 31.68 for FSASC-ineligible patients (p Conclusions: Roughly 1 in 5 patients is ineligible for surgery at a freestanding ASC due to disqualifying comorbidities. Although FSASCs offer cost effective care that satisfies patients, we must understand that certain patients cannot have their surgeries at these venues. In addition, we must use additional caution when scheduling certain procedures at a FSASC. Therefore, as the number and complexity of the surgeries performed at FSASCs increase, we must better understand the factors that make patients better candidates for surgery in a hospital setting, thus minimizing transfers and readmissions and maximizing the value proposition of FSASCs. In the USA, ambulatory surgeries have increased in number over the last three decades and now comprise the majority of surgeries performed. According to the National Center for Health Statistics, outpatient procedures increased from 16% in 1980 to 63% in 2005. (1) Factors contributing to this rise include advancements in minimally invasive surgical techniques, improved postoperative pain control, and in the case of Medicare, congressionally mandated incentives that have shifted the focus away from the inpatient setting. (2) The number of freestanding ambulatory surgery centers (FSASCs) has grown rapidly over the past two decades, from 239 in 1983 to well over 3,300 in the 2000's. Moreover, the number of surgical procedures performed at FSASCs annually grew from 380,000 in 1983 to 31.5 million in 1996. (3) These centers offer a cost-effective and efficient alternative to ambulatory procedures performed in a hospital setting. However, FSASCs are not equipped to deal with complications that can be handled by hospital-based centers. Between 2007 and 2012, prices paid to FSASCs grew in accordance with general medical care prices, whereas prices paid to hospital outpatient departments rose sharply for the same procedures. (4) Additionally, FSASCs provide quality care in an efficient manner. The average procedural times are lower in FSASCs, including time spent in the...
Source Citation (MLA 8 th Edition)
Siow, Matthew, et al. "An evaluation of patient risk factors to determine eligibility to undergo orthopaedic surgery in a freestanding ambulatory center: a survey of 4,242 consecutive patients." Bulletin of the NYU Hospital for Joint Diseases, vol. 75, no. 3, 2017, p. 201+. Academic OneFile, Accessed 21 Jan. 2018.

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