 |
|
Inpatient Hospital Admission and Death After Outpatient Surgery in Elderly Patients
Importance of Patient and System Characteristics and Location of Care
Lee A. Fleisher, MD;
L. Reuven Pasternak, MD, MBA, MPH;
Robert Herbert, BS;
Gerard F. Anderson, PhD
Arch Surg. 2004;139:67-72.
Hypothesis Surgery at different outpatient care locations in the higher-risk elderly (age >65 years) population is associated with similar rates of inpatient hospital admission and death.
Design Claims analysis of patients undergoing 16 different surgical procedures in a nationally representative (5%) sample of Medicare beneficiaries for the years 1994 through 1999.
Setting Hospital-based outpatient centers, freestanding ambulatory surgery centers (ASCs), and physicians' office facilities.
Patients Medicare beneficiaries older than 65 years.
Main Outcome Measures Rate of death, emergency department risk, and admission to an inpatient hospital within 7 days of outpatient surgery.
Results We studied 564 267 outpatient surgical procedures: 360 780 at an outpatient hospital, 175 288 at an ASC, and 28 199 at a physician's office. There were no deaths the day of surgery at a physician's office, 4 deaths the day of surgery at an ASC (2.3 per 100 000 outpatient procedures), and 9 deaths the day of surgery at an outpatient hospital (2.5 per 100 000 outpatient procedures). The 7-day mortality rate was 35 per 100 000 outpatient procedures at a physician's office, 25 per 100 000 outpatient procedures at an ASC, and 50 per 100 000 outpatient procedures at an outpatient hospital. The rate of admission to an inpatient hospital within 7 days of outpatient surgery was 9.08 per 1000 outpatient procedures at a physician's office, 8.41 per 1000 outpatient procedures at an ASC, and 21 per 1000 outpatient procedures at an outpatient hospital. In multivariate models, more advanced age, prior inpatient hospital admission within 6 months, surgical performance at a physician's office or outpatient hospital, and invasiveness of surgery identified those patients who were at increased risk of inpatient hospital admission or death within 7 days of surgery at an outpatient facility.
Conclusion This study represents an initial effort to demonstrate the risk associated with outpatient surgery in a large, diverse population of elderly individuals.
From the Departments of Anesthesiology (Drs Fleisher and Pasternak), Medicine (Drs Fleisher and Anderson), and Health Policy and Management (Drs Fleisher, Pasternak, and Anderson and Mr Herbert), Johns Hopkins University, Baltimore, Md.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
This Month in Archives of Surgery
Arch Surg. 2004;139(1):13.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
American College of Cardiology Foundation et al.
J Am Coll Cardiol 2009;54:e13-e118.
FULL TEXT
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
2007 WRITING COMMITTEE MEMBERS et al.
Circulation 2009;120:e169-e276.
FULL TEXT
Cardiac risk stratification for noncardiac surgery: Update from the American College of Cardiology/American Heart Association 2007 guidelines
FLEISHER
Cleveland Clinic Journal of Medicine 2009;76:S9-S15.
ABSTRACT
| FULL TEXT
Quality of Care Differs by Patient Characteristics: Outcome Disparities After Ambulatory Surgical Procedures
Menachemi et al.
American Journal of Medical Quality 2007;22:395-401.
ABSTRACT
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery
Fleisher et al.
J Am Coll Cardiol 2007;50:e159-e242.
FULL TEXT
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Fleisher et al.
Circulation 2007;116:e418-e500.
FULL TEXT
Ambulatory care adverse events and preventable adverse events leading to a hospital admission
Woods et al.
Qual Saf Health Care 2007;16:127-131.
ABSTRACT
| FULL TEXT
The Safety of Office-Based Surgery: Review of Recent Literature From Several Disciplines
Hancox et al.
Arch Dermatol 2004;140:1379-1382.
ABSTRACT
| FULL TEXT
|
