Should I have my surgery in the hospital or in an ambulatory surgery center?

Should I have my surgery in the hospital or in an ambulatory surgery center?

Ambulatory surgery centers (ASCs) are modern, standalone healthcare facilities that allow patients to have surgery without being admitted to a hospital. In the last few decades, ASCs have risen in popularity—and for good reason.

Ambulatory centers offer a number of benefits to patients including shorter procedure times than in a hospital, convenient, same-day surgery, and increased affordability. Though almost 50% of outpatient surgical procedures are now done in ambulatory surgery centers, many patients are uncertain about whether this setting is right for their surgery.

If you’ve been told you need surgery, you may be wondering the same. Below, we’ll go over who is eligible for outpatient surgery, who is not, which procedures you can have as an outpatient, and when it’s better to have surgery at a hospital.

Who is eligible for outpatient surgery?

Outpatient surgery is a safe, convenient, and affordable option for many people. Generally, if your doctor recommends that you have outpatient surgery, it’s probably ok to do so. Patients for whom it is considered very safe to have outpatient surgery are those that are:

  • In overall good health
  • Not obese
  • Age 65 or younger
  • Having a minimally invasive or low-risk procedure

These are general guidelines but remember, your doctor is the only one who will be able to tell you for certain if you are a good candidate for outpatient surgery.

Who should not have surgery as an outpatient?

It’s important to note that not all patients are candidates for outpatient surgery. Patients who are deemed high risk may be required to have their surgery as an inpatient. As surgical procedures become more advanced and less invasive, ASCs are able to perform more complicated surgeries than before. When you have a preexisting health condition that puts you at high risk for complications during surgery, having a more complicated procedure in an ASC isn’t the best idea.

While ASCs are required to have an emergency preparedness plan, high-risk patients may need more emergency care than a center is prepared for. Patients who meet the following criteria may not be good candidates for ambulatory surgery:

  • Need an invasive or high-risk procedure

And/or meet any of the following conditions:

  • Age over 65
  • BMI considered overweight or obese
  • Obstructive lung disease
  • Hypertension
  • History of heart attack or stroke
  • Previous cardiac intervention
  • Prolonged operating room time during past surgeries

These conditions don’t necessarily disqualify you but if any of the above apply to you, have a conversation with your doctor about whether an inpatient surgery may be more appropriate. There’s also a middle ground; you may be able to have your procedure in the hospital without being admitted for an overnight stay. Your doctor will be able to give you an answer specific to your personal situation.

Which surgeries can be performed in an outpatient setting?

Procedure % Performed as outpatient
Gastric Bypass Weight-Loss 99%
Meniscus removal 98%
Bunion repair 98%
Arthroscopy 98%
Peripheral nerve decompression 95%
Joint structure division 82%
Other musculoskeletal procedures, excluding hip/knee replacement, amputations and spinal fusion 73%
Joint replacement other than hip/knee 56%
Partial excision bone 44%
Fracture treatment 40%
Spinal decompression 30%

(Chart represents 70% of musculoskeletal and spinal procedures in the 2013 HCUP National Inpatient and State Ambulatory Surgery Dataset.)

Should I have my surgery in a hospital or as an outpatient?

Having surgery can be scary, even if it’s not a high-risk procedure. As an outpatient, you will stay a few hours after your procedure for observation before being discharged and sent home (or to your hotel, if you traveled for your procedure). Between 4 and 7 days later, you will return for a follow-up appointment. Of course, your doctor and your Carrum Concierge will be available for questions in between.

As an inpatient, you’ll be admitted to the hospital for your surgery and then stay for one day to one week, depending on the type of surgery and your health. You will still likely have follow up appointments, as well as have access to your doctor and your Carrum Concierge to ask questions. The main difference between inpatient and outpatient care is whether or not you stay the night in the hospital.

Hospitals have long been the go-to place for surgeries, as well as non-surgical procedures. As healthcare costs rise and insurance deductibles are getting higher, many patients are looking for alternatives to traditional healthcare—including where they receive care. For many musculoskeletal procedures, outpatient surgery can be a safe and less stressful experience than an inpatient surgery. In fact, many procedures just aren’t done as much in the inpatient setting anymore.

If you’ve been approved as a good candidate for outpatient surgery, it’s time to weigh other factors. There’s no right or wrong answer to whether you should or should not have surgery in an ASC. Instead, there are several considerations you can make to decide if it’s right for you, and right for this surgery.

Pros and cons of having surgery as an outpatient

There are many benefits to having outpatient surgery, as well as a few disadvantages that should be considered before making a decision. These points are meant to help you think through your options; you and your doctor should come to a final decision together.

Benefits of outpatient surgery

  • Access to same-day surgeries, so you can get back to your life faster
  • Reduced risk of hospital-acquired infections—the less time you spend in a hospital, the lower your chances of becoming infected
  • Shorter procedure times than in a hospital
  • Increased affordability (but if you’re using your Carrum Health benefit you pay nothing out-of-pocket)*
  • Reduced stress—less time off work and away from family
  • Improved predictability of surgery schedule—lower risk of having to wait long or reschedule due to emergencies taking precedence

Disadvantages of outpatient surgery

  • Complications and emergencies require transfers to a nearby hospital
  • No overnight facilities (this is also a benefit, depending on how you look at it)
  • Only capable of certain procedures

When is it better to have surgery in a hospital?

Since there are some disadvantages of going to an ASC for your surgery, that naturally means that there are some benefits of having it at a hospital. If you’re worried about recovering outside of a hospital or about potential complications, feel free to talk to your doctor about whether it makes more sense to have inpatient surgery. Ultimately, it’s most important that you feel comfortable and safe every step of the way.

When you use your Carrum Health surgery benefit, your Carrum Concierge will help you determine whether you’re a candidate for outpatient surgery. If you’re interested, register and explore the outpatient surgeries we offer.

*Per IRS rules, a portion of the covered travel expenses will be reported as taxable income to the employee. Due to IRS regulations, on HSA plans the deductible applies but coinsurance is waived.