Squitieri Lee, Ko Clifford Y, Brook Robert H, Chung Kevin C
RAND Corporation, Santa Monica, Calif.
Adventist Health White Memorial, Los Angeles, Calif.
Plast Reconstr Surg Glob Open. 2021 Feb 18;9(2):e3442. doi: 10.1097/GOX.0000000000003442. eCollection 2021 Feb.
Little is known about the volume and scope of surgical procedures performed in ambulatory surgery centers (ASCs) and the resources that ASCs may provide to assist local health systems. The purpose of this study was to evaluate elective surgical procedures in the inpatient and outpatient ASC setting using currently available administrative claims data.
We used the 2019 Medicare Point of Service (POS) file to evaluate the geographic distribution of Medicare-certified ASCs in the U.S. To evaluate the volume and scope of elective procedures in the inpatient and outpatient ASC setting, we used the 2016 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the 2018 California HHS Open Data Portal ambulatory surgery database. HCUP software programs were used to clinically categorize procedures and determine Elixhauser comorbidity profiles for each patient.
Among the 8,540 Medicare certified ASCs in 2019, the majority are freestanding (99.5%) and privately owned (92.9%). In the inpatient setting, 13.3% of elective operating room procedures occur in patients without any Elixhauser comorbidities and require < 2 days of hospital stay. However, the types of elective procedures performed in the inpatient setting are different from the types of procedures routinely performed in ASCs.
Current administrative data lack robust facility, provider, and procedure level information to inform surge capacity protocols for elective surgery. Plastic surgeons are uniquely positioned to work with other specialties and local health systems to guide future development of surge capacity protocols that maintain and improve patient care.
关于门诊手术中心（ASC）所实施手术程序的数量和范围，以及ASC可为当地卫生系统提供的资源，我们知之甚少。本研究的目的是利用当前可用的行政索赔数据，评估住院和门诊ASC环境下的择期手术程序。
我们使用2019年医疗保险服务点（POS）文件来评估美国医疗保险认证的ASC的地理分布。为了评估住院和门诊ASC环境下择期手术程序的数量和范围，我们使用了2016年医疗保健成本与利用项目（HCUP）全国住院样本（NIS）和2018年加利福尼亚州卫生与公众服务部开放数据门户门诊手术数据库。HCUP软件程序用于对手术进行临床分类，并确定每位患者的埃利克斯豪泽共病概况。
在2019年的8540家医疗保险认证的ASC中，大多数是独立的（99.5%）且为私人所有（92.9%）。在住院环境中，13.3%的择期手术室手术发生在没有任何埃利克斯豪泽共病且住院时间少于2天的患者身上。然而，住院环境中实施的择期手术类型与ASC中常规实施的手术类型不同。
当前的行政数据缺乏强大的机构、提供者和程序层面信息，无法为择期手术的应急能力方案提供参考。整形外科医生具有独特的地位，能够与其他专业和当地卫生系统合作，以指导未来应急能力方案的制定，从而维持和改善患者护理。
