63 INCREASING RATE OF FLUOROQUINOLONE RESISTANT ESCHERICHIA COLI AND INCIDENCE OF INFECTIOUS COMPLICATIONS FOLLOWING TRUS GUIDED PROSTATE NEEDLE BIOPSY IN CALGARY, ALBERTA, CANADA

Abstract

INTRODUCTION AND OBJECTIVES: Delivery settings for outpatient procedures have evolved over the past two decades to include various non-hospital based facilities, including ambulatory surgery centers (ASCs). The purpose of these facilities was to redistribute appropriate patients from the more expensive hospital setting without compromising quality. The objective of this study was to assess the impact of ASCs opening on rates of procedures performed in hospital-based outpatient facilities and on adverse events following these procedures. METHODS: This is a retrospective cohort study of Medicare beneficiaries undergoing ambulatory surgery between 2001 and 2009 at either hospital or freestanding ASCs. Ophthalmologic, gastrointestinal, musculoskeletal, and urologic procedures were evaluated. Difference-in-difference methods were used to estimate the effects of ASCs opening on outcomes at the level of the Hospital Service Area (HSA), including population-based rates of hospital-based outpatient surgery, mortality, and hospital admission within 30 days of an outpatient procedure. RESULTS: The number of freestanding ASCs in the US increased from 3,378 in 2001 to 4,573 in 2009. Rates of utilization of hospital-based outpatient surgery (overall) and outpatient urological surgery according to ASC capacity are shown in the figure. Markets where ASCs were added showed large declines in rates of hospitalbased urologic outpatient surgery, from 59.2 urologic procedures per HSA at baseline, to 45.5 and 39.1 at 2 and 4 years after ASC opening, respectively. Trends were similar for ophthalmologic, gastrointestinal, and musculoskeletal outpatient procedures. Mortality and hospital admission rates within 30 days of outpatient surgery remained stable for all specialties after ASC openings. CONCLUSIONS: The opening of an ASC in a healthcare market resulted in significant declines in corresponding hospital-based surgery without increasing population-based mortality or hospital admission. This suggests that ASCs can successfully offload procedures from the more expensive hospital setting without negatively impacting quality on a population level.