Surgical Procedures Continue to Shift to Outpatient

A new study published in Jama Network Open reported the continuation of the shift of surgical procedures to the outpatient environment. According to the report, during the COVID-19 pandemic hospitals shifted certain procedures to outpatient settings as they adapted to limited resources and attempted to reduce the risk of coronavirus infections. For the study, researchers analyzed case volumes for the 16 most common general surgeries in the American College of Surgeons (ACS) National Surgical Quality Improvement Program. Outpatient procedures were defined as procedures where patients were discharged the same day.

Patients were divided into two groups: Those who had received surgery between January 2016 and December 2019, and those who had received surgery between January 2020 and December 2020. A total of 823,746 patients received surgery before the pandemic, and 164,690 patients received surgery during the pandemic. Among the patients, the average age was 54.5 years, with 58.1% being women.

The study indicated that there was a disproportionate number of outpatient cases for eight common surgeries in 2020 compared to the few years prior to the pandemic. Four procedures also had a clinically significant increase in outpatient volumes between 2016 and 2020, including mastectomy for cancer, thyroid lobectomy, minimally invasive ventral hernia repair, and parathyroidectomy.

In early 2020, the American College of Surgeons and other organizations published elective case triage guidelines to help hospitals more effectively balance limited resources and reduce coronavirus infections. “These guidelines recognize that postoperative inpatient admission uses key hospital resources that need to be allocated toward the care of acutely unwell patients with COVID-19 and exposes patients undergoing routine surgery to the risk of nosocomial COVID-19 infection,” the researchers wrote.

According to a MedPage Today interview with Adrian Diaz, MD, general surgery resident at The Ohio State University in Columbus, he said the study’s findings are consistent with his experience – and the trend may continue for years. In fact, Diaz suggested that outpatient surgery may be the preference for many patients due to convenience and cost.

“I believe this study is further evidence that more and more surgery is moving to an outpatient setting. Although this study did not assess safety or outcomes, the trends in the study demonstrate that most providers feel comfortable performing these operations in an outpatient setting,” he told MedPageToday. OSM