Unplanned hospital admissions post ASC visits remain exceptionally low, study finds

Editor's Note

A large-scale study of over 50,000 ambulatory surgery center (ASC) procedures shows a strikingly low rate of 24-hour unplanned postoperative hospital admissions, offering a benchmark that other ASCs can strive to match, General Surgery News March 26 reports. Over a 7-year period from 2016 to 2022, researchers at a hospital-affiliated ASC found an overall unplanned admission rate of only 0.09%—a figure that remained below 0.12% each year.

According to study lead Syed Shah, MD, an associate professor and interim chairman of anesthesiology at Stony Brook University Renaissance School of Medicine, the drive to shift more surgical procedures to ASCs for capacity and patient satisfaction highlights why unplanned admissions function as a key quality-of-care measure. Notably, previous studies reported higher admission rates—up to 2%—but typically measured 30-day readmissions rather than focusing on the immediate postoperative window.

Researchers mined electronic health records for adult patients and evaluated potential causes for unplanned admissions. Surgical factors were the most common culprits, including bleeding, hematoma formation, complications requiring observation, pain management, and urinary retention. Medical causes ranged from atrial fibrillation and cardiac dysrhythmias to chest pain, respiratory issues, and glycemic abnormalities. On the anesthesia front, postoperative nausea and vomiting stood out as leading contributors.

Multivariate analyses highlighted several independent risk factors for admission. Longer surgical duration increased risk (odds ratio [OR], 1.01; P<0.0001), while patients with peripheral vascular disease (OR, 14.49; P<0.0001) or deep vein thrombosis (OR, 5.53; P=0.0016) were also more prone to requiring unplanned hospital care. Interestingly, no significant correlation emerged with advanced age, higher BMI, obstructive sleep apnea, or ASA physical status—suggesting that older or heavier patients can still be carefully managed for procedures in an ASC setting.

Still, Dr Shah emphasized that patient selection plays a major role: being only a 1-minute drive from a full-service hospital helps mitigate risk. While some ASCs might need to be more conservative if located far from emergency resources, these findings suggest that even relatively complex surgical procedures can be performed safely in an ASC environment under the right conditions.