Study explores benefits of hand and shoulder surgeries performed at outpatient centers

A large study of hand and shoulder surgeries performed at a freestanding, outpatient center found few complications--0.2 percent in nearly 29,000 patients over an 11-year period. The study appears in the new issue of the Journal of Bone and Joint Surgery.

Previous studies have documented the benefits of surgery conducted at outpatient centers, including cost savings and specialization. These centers become more adept and efficient as they perform high quantities of the same surgical procedure. Despite the increase in outpatient procedures, "there remains a paucity of literature on safety," said lead study author, Kanu S. Goyal, MD, an orthopaedic surgeon at The Ohio State University Wexner Medical Center.

In this study, researchers reviewed the outcomes of 28,737 procedures performed from 2001 to 2012 at a freestanding ambulatory surgical center in Wexford, Pa. specializing in hand and upper extremity surgery. Healthy patients with few or no comorbidities--conditions or diseases known to exacerbate surgical complications--are more likely to be treated at outpatient centers.

Cases were reviewed for adverse events including post-operative infection requiring intravenous antibiotics or return to the operating room, post-operative transfer to a hospital, wrong-site surgery, surgical items left in the patient, post-operative deep vein thrombosis (VTE) or blood clots, medication error, and other complications related to surgery.

There were 58 reportable adverse events for an overall complication rate of 0.2 percent: 14 patients sustained an infection, 18 required transfer to a hospital for additional care, and 21 were admitted to the hospital after discharge from the surgical center. There was one medication error and four post-operative blood clots. There were no cases of wrong-site surgery, retained surgical items or death.

"Our study shows that with proper patient selection, hand and upper extremity surgery can be completed safely at a free-standing ambulatory surgery center," said Dr. Goyal.