Nearly 58 percent of all surgeries performed in community hospitals in 2007 were outpatient procedures, according to a report published last week by the federal Agency for Healthcare Research and Quality.

Colonoscopies were the most commonly performed hospital-based outpatient procedure, with 18.1% of surgeries. "In fact," write the report's authors, "more ambulatory surgeries involved the digestive system (40%) than any other body system." Upper GI endoscopy and biopsy (10.8%) and lens and cataract procedures (5.5%) rounded out the top 3.

The report noted the comparative economy of ambulatory surgery as compared to inpatient procedures, with the average hospital outpatient case costing $6,100 versus $39,900 for a hospital stay.

AHRQ researchers, working with Washington, D.C.-based Thomson Reuters Healthcare Research, reviewed ambulatory surgery data from 28 states - representing two-thirds of the nation's population - for their study. The data came from private and public community hospitals but did not include ambulatory surgery centers or federal healthcare facilities.

Nationally, 61% percent of all surgical procedures in 2006 were done on an outpatient basis, with 57% of outpatient procedures performed in hospitals, according to separate data compiled in the National Survey of Ambulatory Surgery Report updated in 2009 by the National Center for Health Statistics. That report also recorded the rate of surgical visits to ASCs rising 300% between 1996 and 2006, while outpatient surgical visits to hospitals remained constant.

The AHRQ report cites 2 factors for the growth of outpatient surgery. "Advances in surgical technology and anesthesia have made surgery easier on patients and increased the demand for outpatient procedures," write the authors, and "to reduce rising healthcare costs, healthcare payment policies have encouraged [ambulatory surgery]."

Kent Steinriede

Spinal cord stimulation may be no better than other methods of chronic pain management for patients who've suffered failed back surgeries, according to a new study of outcomes from the University of Washington.

The findings, published in the journal Pain, focus on 3 groups of workers' compensation patients in Washington state suffering chronic back and leg pain. The patients underwent either spinal cord stimulation (SCS) therapy, in which an implanted device sent electrical pulses to the spine; pain clinic treatment; or standard medical treatment for chronic back and leg pain.

In a follow-up examination 1 to 2 years after treatment, patients in the SCS group didn't differ from those in the other groups in their levels of pain intensity, mental health, function or opioid medication use. The SCS group showed better leg pain scores than the other groups after 6 months, but relied more heavily on daily opioid use, according to the study.

Outcomes were poor in each studied group, note the authors, and at baseline "there were indications that the SCS group was at higher risk than the other groups for poor outcomes." Still, while they found "little evidence for the superiority of SCS over alternative treatments" among the groups they studied, "the lack of long-term effectiveness of SCS in this study does not necessarily imply ineffectiveness in other settings." The authors suggest that the patients' involvement in the workers compensation system may have had a greater influence on their poor outcomes than the types of therapies they received.

Irene Tsikitas

Patients who undergo revisional bariatric surgery appear to be at greater risk of suffering post-op complications than they were following the original weight-loss procedure, according to a study appearing in the February Archives of Surgery.

A team of researchers at the University Hospital of Patras in Rion, Greece, tracked 56 patients who underwent revisional surgery between 1995 and 2008 to correct inadequate weight loss, severe nutritional complications and intolerable side effects. At 30 to 90 days post-op, 19 patients experienced internal leaking from the revised surgical site, acute kidney failure or pneumonia, according to the study. Beyond 90 days post-op, 9 patients suffered hernias at the incision site, 2 patients experienced narrowing of the passageway between the stomach and intestine, and hypoalbuminemia was discovered in 2 patients, note the researchers.

However, the researchers point out, the ultimate outcomes of revisional procedures are largely positive. They say that on average, patients undergoing a second procedure to improve inadequate weight loss see their body mass index drop from 55 to 35. Patients who experienced nutritional complications or intolerable side effects reported those issues resolved after the second surgery.

The researchers say bariatric surgery is safe and effective when performed by experienced surgeons in facilities with a conservative approach to patient selection. However, they also say that addressing and limiting the risks of revisional procedures is critical to the future of a specialty growing in popularity as more patients demand surgical interventions to control their weight and physicians begin to prescribe weight-loss surgery to treat severe metabolic disorders.

Daniel Cook

What's your policy on letting your eye surgery patients wear their street clothes in the OR, without having to change into gowns? Weigh in on this week's poll question online. We'll report the results in this space next week.

In our most lopsided InstaPoll vote ever, 93% of the 152 respondents to last week's poll said they are in favor of mandatory accreditation for office-based surgical facilities.

Dan O'Connor