Ambulatory Surgery

AMBULATORY surgery is a landmark innovation in surgical care. The shift from inpatient to outpatient surgery since the 1970s, achieved through technological advances and sustained by patient and provider preferences, was driven largely by payment system changes. Ambulatory surgery accounts for 50% of all surgery in the United States, while in Europe, where financing mechanisms and practice patterns differ, only 10% of surgery, on average, is outpatient. Freestanding ambulatory surgery centers in the United States, often hospital-independent, deserve attention, given excess hospital capacities and data suggesting higher costs. Because ambulatory surgery produces outcomes equivalent to those of inpatient surgery at considerable per-patient savings, the burgeoning managed care market should favor its growth. However, unless ambulatory surgery's gains are matched with corresponding declines in inpatient surgery and services (staffing and beds), significant savings in total health expenditures will not result. In the present debate on health care reform, the costs and