In today’s healthcare environment, surgical procedures may be performed in a variety of different settings. Choosing between a surgery center and a hospital is a big decision for patients, and many factors come into play when determining which option is best. Surgery centers, also known as ambulatory surgery centers (ASCs), are licensed, freestanding outpatient facilities. These centers are often physician-owned, may specialize in certain procedure and are typically smaller than hospitals. Surgery centers have become increasingly prevalent, and more surgeries are being performed at such facilities, particularly because of advances in anesthesia that have increased the provision of ambulatory anesthesia services. Clinical advances in technology, financial incentives, and a greater demand for lower-cost and higher quality care have also contributed to the rise in surgery centers. The volume, age, and complexity of the outpatient surgical population has grown, and more patients are now facing the choice between different surgical settings .
When deciding between a hospital or a surgery center, one must first determine that the patient’s case is appropriate for an ambulatory surgery setting. Unlike hospitals, surgery centers do not have various support departments such as MRI suites and ICUs, and there have been concerns in regards to their ability to handle major problems during surgery. Hospitals have more resources to manage complications, and patients are often transferred from a surgery center to the nearest hospital facility should complications arise during a procedure. Patient selection is essential to ensure safety in a surgery center, as not all patients are candidates for outpatient surgery. The procedure, personnel involved, patient’s medical status, and surgical setting all affect the patient selection process. Anesthesia also plays a critical role, since the requirement of anesthesia and the type of anesthesia provider, be it an anesthesiologist, a CRNA, or a surgeon and nurse, are key factors in patient selection . A study on risk factors for major morbidity and mortality from outpatient surgery revealed that patients with cerebrovascular disease, obesity, cardiac disease, or prolonged surgery face greater risk, making a hospital generally more appropriate for such cases . Frail older adults may have stronger reactions to anesthesia and may be more likely to experience surgical complications and take longer to heal, therefore they should consider surgery at a hospital setting as well .
While hospitals are often better suited for higher risk surgical cases, research has shown that surgery centers have many advantages over hospital facilities. Due to lower overhead, fixed costs, and the inability of patients to stay overnight, surgery centers often cost 45-60% less than a hospital setting. One study revealed that surgery center performance generally exceeds that of a hospital-based facility and that the quality of surgery was superior if not equal to a hospital . Surgery centers are able to exercise increased control over procedure scheduling, resulting in reduced procedure delay and rescheduling, and they have been shown to perform procedures more efficiently than a hospital-based facility. Additionally, while surgical site infection rates are low in both surgical settings, surgery centers experience lower rates on average than hospitals .
Choosing a facility ultimately depends on each individual circumstance. There are benefits and drawbacks to both hospitals and surgery centers, and studies have shown similar positive patient experiences at both types of facilities . Not all patients are suitable for outpatient procedures, and hospitals are more appropriate for complicated, risky cases as well as procedures that require greater observation and recovery times. However, for patients who are eligible for outpatient surgery, surgery centers offer a higher quality, lower-cost alternative to hospitals.
References http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1918045  http://www.sciencedirect.com/science/article/pii/S0094129813000291?via%3Dihub  https://www.consumerreports.org/surgery/get-the-best-care-at-an-ambulatory-surgery-center/  https://www.sciencedirect.com/science/article/pii/S0194599809014788  https://www.beckershospitalreview.com/quality/ssi-rates-hospitals-vs-ascs-2010.html  https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2013.1281  https://www.advisory.com/daily-briefing/2014/09/16/are-surgery-clinics-less-safe-than-hospitals
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