ImportanceIn surgical patients, it is well known that higher hospital procedure volume is associated with better outcomes. To our knowledge, this volume-outcome association has not been studied in ambulatory surgery centers (ASCs) in the US.ObjectiveTo determine if low-volume ASCs have a higher rate of revisits after surgery, particularly among patients with multimorbidity.Design, Setting, and ParticipantsThis matched case-control study used Medicare claims data and analyzed surgeries performed during 2018 and 2019 at ASCs. The study examined 2328 ASCs performing common ambulatory procedures and analyzed 4751 patients with a revisit within 7 days of surgery (defined to be either 1 of 4735 revisits or 1 of 16 deaths without a revisit). These cases were each closely matched to 5 control patients without revisits (23 755 controls). Data were analyzed from January 1, 2018, through December 31, 2019.Main Outcomes and MeasuresSeven-day revisit in patients (cases) compared with the matched patients without the outcome (controls) in ASCs with low volume (less than 50 procedures over 2 years) vs higher volume (50 or more procedures).ResultsPatients at a low-volume ASC had a higher odds of a 7-day revisit vs patients who had their surgery at a higher-volume ASC (odds ratio [OR], 1.21; 95% CI, 1.09-1.36; P = .001). The odds of revisit for patients with multimorbidity were higher at low-volume ASCs when compared with higher-volume ASCs (OR, 1.57; 95% CI, 1.27-1.94; P < .001). Among patients with multimorbidity in low-volume ASCs, for those who underwent orthopedic procedures, the odds of revisit were 84% higher (OR, 1.84; 95% CI, 1.36-2.50; P < .001) vs higher-volume centers, and for those who underwent general surgery or other procedures, the odds of revisit were 36% higher (OR, 1.36; 95% CI, 1.01-1.83; P = .05) vs a higher-volume center. The findings were not statistically significant for patients without multimorbidity.Conclusions and RelevanceIn this observational study, the surgical volume of an ASC was an important indicator of patient outcomes. Older patients with multimorbidity should discuss with their surgeon the optimal location of their care.

中文翻译：

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评估门诊手术中心的容量与结果关联

重要性对于手术患者来说，众所周知，医院手术量越大，预后越好。据我们所知，这种手术量与结果之间的关联尚未在美国的门诊手术中心 (ASC) 中进行过研究。目的确定小手术量 ASC 术后复诊率是否较高，特别是在患有多种疾病的患者中。设计、设置、这项匹配的病例对照研究使用了医疗保险索赔数据，并分析了 2018 年和 2019 年在 ASC 进行的手术。该研究检查了 2328 名执行普通门诊手术的 ASC，并分析了 4751 名在手术后 7 天内进行复诊的患者（定义为 4735 例复诊中的 1 例或 16 例未经复诊死亡的患者中的 1 例）。这些病例均与 5 名未经复诊的对照患者（23 755 名对照）密切匹配。数据分析时间为 2018 年 1 月 1 日至 2019 年 12 月 31 日。主要结果和措施在小容量 ASC 中（2 年内进行的手术少于 50 次），对患者（病例）进行 7 天的复诊，与没有结果的匹配患者（对照）进行比较年）与较大手术量（50 次或更多手术）相比。结果与在较高手术量 ASC 中接受手术的患者相比，接受低手术量 ASC 的患者进行 7 天复诊的几率更高（比值比 [OR]，1.21； 95% CI，1.09-1.36；磷= .001)。与高容量 ASC 相比，低容量 ASC 中患有多种疾病的患者复诊的几率更高（OR，1.57；95% CI，1.27-1.94；磷< .001）。在小体积 ASC 中患有多种疾病的患者中，对于接受过骨科手术的患者来说，复诊的几率要高出 84%（OR，1.84；95% CI，1.36-2.50；磷< .001）与大容量中心相比，对于接受普通手术或其他手术的患者来说，复诊的几率要高出 36%（OR，1.36；95% CI，1.01-1.83；磷= .05) 与更高容量的中心相比。对于没有多种疾病的患者，这些结果没有统计学意义。结论和相关性在这项观察性研究中，ASC 的手术量是患者预后的重要指标。患有多种疾病的老年患者应与外科医生讨论最佳的护理地点。