Neurosurgeons have described the move toward outpatient care in cautious terms for years — less as a sudden turn and more as a gradual reassessment of which cases may be appropriate outside the hospital. A new study from the University at Buffalo (N.Y.) offers a closer look at the potential operational differences between the settings.
Researchers in the department of neurosurgery at the university’s Jacobs School of Medicine and Biomedical Sciences compared elective neuroendovascular procedures performed at an ambulatory neurosurgery center with the same procedures performed at a tertiary hospital.
The findings, published June 1 in Stroke: Vascular and Interventional Neurology, found that patients undergoing a diagnostic cerebral angiogram spent an average of 4.6 hours at an ambulatory center, compared with 9.4 hours at a hospital. Researchers matched patients for age and diagnosis to account for the possibility that differences in patient populations contributed to the results. Turnover time between cases averaged 12 minutes at an ambulatory site, compared with 30.6 minutes at a hospital. The first case of the day also started earlier and more predictably at the ambulatory center.
The authors pointed to factors such as inpatient transport delays, staffing gaps and competing emergent cases as potential contributors to hospital scheduling differences.
“This is the first study, to our knowledge, to demonstrate a similar reduction in preprocedural and postprocedural time for neuroendovascular procedures performed specifically within the angiography suite,” the authors wrote.
A trend surgeons have been watching
The findings add another data point to a broader discussion among neurosurgery leaders about which procedures may be suited to outpatient settings.
John Golfinos, MD, chair of New York City-based NYU Langone Health’s neurosurgery department, said he is closely watching how the neurosurgery industry will manage the shift to outpatient.
“As long as the outcomes are better by doing it in an outpatient setting — if it’s better and safer, that’s the kind of thing we all love.” He noted the shift does not move at the same pace everywhere — academic medical centers and large health systems face structural obstacles smaller practices do not — but said declining physician fees could give departments across specialties more reason to consider outpatient models.
John O’Toole, MD, chair of neurological surgery at Chicago-based Rush University, describing the view from inside a multihospital system, framed the issue as an ongoing recalibration rather than a single decision.
“The migration of reimbursements from inpatient to outpatient is a challenge facing the institution that will obviously then get translated onto us in terms of how we’re moving patients through the system,” he said. Sorting out “the right procedure by the right person in the right place,” he said, is “a constantly moving target,” one that requires matching infrastructure and staffing to the appropriate site of care while planning for the rare case that does not go as expected.
“That’s definitely one of the ongoing challenges, but one that I think is actually exciting, because it allows us to think about growth and strategy in a different way,” Dr. O’Toole said.
Not a wholesale shift
The findings do not suggest every case is headed to an ASC. The University at Buffalo study is a single-center analysis with a modest ambulatory sample, 155 procedures compared with 1,174 at the hospital. The authors cautioned that some of the differences may reflect a less complex, elective-only patient population at the ambulatory site rather than an inherent advantage of the ambulatory model itself. Complex cases, emergent care and medically fragile patients may continue to require hospital-based care.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
