Editorial Commentary: Is This the Beginning of the End for Hospital-Based Outpatient Surgery Centers? The Wake-Up Call

Abstract

Self-standing ambulatory surgical centers (ASCs) aim, and claim, to decrease cost and improve quality, efficiency, safety, and patient experience. Unsurprisingly, retrospective analysis of prospectively collected data may support some or all of these claims, in comparison to hospital-based outpatient surgery centers, ASC patients may be "cherry-picked" for low morbidity or less complex pathology, to name 2 of many factors, resulting in selection bias, which limits the methodologic ability to answer fully this clinical question. Additional bias is inevitably introduced in many regards if surgeons or anesthesia providers have financial interest in an ASC. With a goal of optimizing health care delivery and equity, solutions could include hospitals, surgeons, and anesthesia providers sharing facility ownership in all settings and patients being made aware of all facility costs and safety profiles, as well as their individual morbidity scores. When surgical intervention is necessary, the experience should be consumer driven, results should be high quality, and transparency should allow the best facilities, whether hospital-based or self-standing ASC, and providers to rise to the top with winners and losers.