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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A-1127
2002 |
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| Safety of Outpatient Surgery in the Elderly: The Importance of the Patient, System and Location of Care | |||||||||||||||||||||||||||||||||
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Lee A. Fleisher, M.D.; Reuven Pasternak, M.D., M.B.A.; Paul G. Barash, M.D.; Gerard Anderson, Ph.D. Anesthesiology, Johns Hopkins University, Baltimore, Maryland |
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Introduction: It is important to continue to assess the safety of diffusing surgery to the outpatient setting, particularly in the higher risk elderly (age >65 years) population. Methods: We determined the rates of death and admission to an inpatient hospital within 7 days of 16 different surgical procedures in a nationally representative (5%) sample of Medicare beneficiaries for the years 1994-1999. Comorbidity was assessed by the presence of an inpatient hospitalization during the 6 months prior to the 3 month period during which the patient had outpatient surgery. Results: A total of 564,267 procedures were studied, with 360,780 in an outpatient hospital (HOSP), 175,288 in an ambulatory surgery center (ASC) and 28,199 in an office. There were no deaths the day of surgery in the office, with 4 deaths in the ASC (2.3 per 100,000) and 9 in the HOSP (2.5 per 100,000). Within 7 days of surgery, there were 10 deaths in the office (35 per 100,000), 43 deaths in the ASC (25 per 100,000) and 179 deaths in the HOSP (50 per 100,000). The rate of admission to an inpatient hospital within 7 days was 9.08 per 1000 in the office, 8.41 per 1000 in the ASC and 21 per 1000 in the HOSP. Multivariate predictors of death and/or admission within 7 days are shown in the table. Discussion: Our work demonstrates that outpatient surgery remains safe, with a mortality of 2.4 per 100,000 cases the day of surgery. The higher rate of adverse events in the outpatient hospital may reflect more complex surgery or an inability to fully risk adjust comorbidity. In multivariate models, the very old, prior admission within 6 months, performance in an office- or hospital-setting and invasiveness of surgery identifies those patients who are at increased risk of admission or death within 7 days. Systems to insure timely access to the healthcare system for complications which occur at home should be considered for this high risk group. Anesthesiology 2002; 96: A1127 |
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