More Than Half of All Hospital Procedures Are Done Outpatient

Nearly 58 percent of the surgeries performed in hospitals were done as outpatient procedures, according to a recent report from the Agency for Healthcare Research and Quality.

In outpatient surgery – also called ambulatory or same-day surgery – patients normally require hospital care for less than 24 hours. These operations are increasingly being used because advances in surgical technology and anesthesia enable surgeons to perform many operations formerly limited to inpatient care.

The federal agency's analysis of data available from 28 States found that in 2007:

·         Charges for outpatient procedures were seven times lower than for inpatient ones. The average hospital charge for an outpatient procedure was $6,100 in 2007, compared with $39,900 for an inpatient procedure.

·         Hospital outpatient surgery charges totaled $55.6 billion, compared with $259 billion for inpatient surgeries.

·         Colonoscopies and resulting biopsies were the most frequently performed outpatient procedure (18 percent of all ambulatory procedures), followed by upper gastrointestinal endoscopies and related biopsies (11 percent), lens and cataract procedures (5.5 percent), and diagnostic cardiac catheterization (4 percent).

These findings are based on data described in Hospital-Based Ambulatory Surgery, 2007. The report uses statistics from 28 states that provide data to the Healthcare Cost and Utilization Project State Ambulatory Surgery Databases and their corresponding State Inpatient Databases. These databases provide information on hospital-based ambulatory and inpatient surgeries performed in short-term, acute care hospitals.

Patients Admitted to Hospitals on a Weekend Wait for Major Procedures

According to another  recent report from AHRQ, of the 8 million patients who were admitted to U.S. hospitals on weekends in 2007, approximately one-third received major procedures on the day of admission.  In comparison, patients who were admitted on weekdays received 65 percent of all major procedures on their first day in the hospital.

Patients were approximately 2.5 times more likely to be admitted on weekends because of emergencies such as heart attack, stomach bleeding, fractures or internal injuries than patients hospitalized on a weekday (28 percent versus 11 percent).  In addition, 65 percent of patients admitted on a weekend were initially seen in hospital emergency departments, compared with 44 percent of weekday-admitted patients.

The analysis also found that:

·         Sixty-four percent of heart attack patients admitted on a weekend had a major cardiac procedure — such as angioplasty or heart bypass surgery — performed by the second day of their hospitalization, compared with 76 percent of heart attack patients admitted on a weekday.

·         In comparison to weekday admissions, a smaller share of weekend admissions received treatment on the day of admission for back surgery (35 percent versus 90 percent); angina (23 percent versus 37 percent); gallbladder removal (23 percent versus 32 percent); and hernia repair (54 percent versus 68 percent).

·         Weekday admissions were often planned in advance: 99 percent of admissions for osteoarthritis and 93 percent of those for back problems occurred on weekdays.

·         About 2.4 percent of patients admitted on a weekend died in the hospital, compared with 1.8 percent of patients admitted on a weekday.

These findings are based on data described in Characteristics of Weekday and Weekend Hospital Admission.  The report uses statistics from the 2007 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.

Hospital Charges For the Uninsured Up Substantially

The amount that hospitals charge the uninsured for inpatient care grew by 88 percent between 1998 and 2007, according to another recent AHRQ report.  After adjusting for inflation, the average charge for an uninsured hospital stay increased from $11,400 in 1998 to $21,400 in 2007.

The analysis found that:

·         From 1998 to 2007, the number of uninsured hospital stays increased by 31 percent, which far exceeds the 13 percent overall increase in hospital stays during the period.

·         The percentage of uninsured hospital stays increased the most in the South, rising from 5.8 percent to 7.5 percent.  In contrast, in the Midwest, the percentage of uninsured hospital stays declined from 4.7 percent to 4.0 percent.

·         The top reason uninsured patients were hospitalized was for childbirth. In 2007, roughly a quarter of a million uninsured women gave birth in hospitals. This was followed by depression and bipolar disorder (94,300); chest pain with no observed cause (77,000); skin infections (which more than doubled from 31,000 to 73,300); and alcohol-related disorders (66,600).

These findings are based on data described in Trends in Uninsured Hospital Stays, 1998-2007.  The report also uses statistics from the 2007 Nationwide Inpatient Sample.

                                                                                                                                     ~P. Hannah Davis