Outpatient setting for urologic procedures doesn't compromise quality of care

Washington-A random sampling of national health care claims data indicates that the use of non-hospital ambulatory facilities as the setting for common outpatient urologic procedures does not adversely affect short-term patient morbidity or mortality.

To better understand how the location of urologic care relates to patient outcomes, Dr. Hollingsworth and colleagues utilized a 5% random sample of national Medicare data to identify a cohort of elderly patients who had undergone one of 22 common outpatient urologic procedures between 1998 and 2006. The study, which was presented by co-author Christopher P. Filson, MD, MS, was conducted as part of the National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Urologic Disease in America Project. Results were presented at the AUA annual meeting in Washington.

Whereas the proportion of procedures performed at ambulatory surgery centers remained relatively constant throughout the evaluation period, the percentage of procedures performed in physician offices increased over time at the expense of hospital outpatient department-based procedures.

The nature of the procedure had a notable influence on facility preference. For example, the physician's office was a common setting for endoscopic bladder surgery, but accounted for only a minority of shockwave lithotripsy procedures. In the current study, patient outcomes were not parsed by individual procedure type.

Adverse events low regardless of setting

Overall, adverse event rates were low for all ambulatory settings. Less than 2% of patients experienced a complication or same-day admission, and the 30-day mortality rate was approximately 1%.

Dr. Hollingsworth noted that while some advantage was observed in favor of outpatient facilities for certain outcomes, the magnitude of the difference was small.

"There was clear selection bias. Specifically, we observed lower-acuity patients-younger and healthier patients-being treated in the physician's office and ambulatory surgery centers," he said. These disparities in patient populations among facilities may have contributed to differences in outcomes.

With regard to continuing trends in outpatient urologic procedure settings, Dr. Hollingsworth posited, "I think there will always be a portion of procedures that will need to be done in a more acute setting, given a patient's level of comorbid illness and case complexity, as well as the availability of required technology within outpatient facilities. So while I see the general trend continuing, I think that the hospital operating room will continue to be critical to outpatient urologic care."