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Inpatient Versus Outpatient Surgery: A Comparison of Postoperative Mortality and Morbidity in Elective Operations

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Abstract

Background

Operations performed outpatient offer several benefits. The prevalence of outpatient operations is growing. Consequently, the proportion of patients with multiple comorbidities undergoing outpatient surgery is increasing. We compared 30-day mortality and overall morbidity between outpatient and inpatient elective operations.

Methods

Using the 2005–2018 ACS-NSQIP database, we evaluated trends in percent of hospital outpatient operations performed over time, and the percent of operations done outpatient versus inpatient by CPT code. Patient characteristics were compared for outpatient versus inpatient operations. We compared unadjusted and risk-adjusted 30-day mortality and morbidity for inpatient and outpatient operations.

Results

A total of 6,494,298 patients were included. The proportion of outpatient operations increased over time, from 37.8% in 2005 to 48.2% in 2018. We analyzed the 50 most frequent operations performed outpatient versus inpatient 25–75% of the time (n = 1,743,097). Patients having outpatient operations were younger (51.6 vs 54.6 years), female (70.3% vs 67.3%), had fewer comorbidities, and lower ASA class (I–II, 69.3% vs. 59.9%). On both unadjusted and risk-adjusted analysis, 30-day mortality and overall morbidity were less likely in outpatient versus inpatient operations.

Conclusion

In this large multi-specialty analysis, we found that patients undergoing outpatient surgery had lower risk of 30-day morbidity and mortality than those undergoing the same inpatient operation. Patients having outpatient surgery were generally healthier, suggesting careful patient selection occurred even with increasing outpatient operation frequency. Patients and providers can feel reassured that outpatient operations are a safe, reasonable option for selected patients.

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Funding

This project was supported by funding from the University of Colorado, Department of Surgery. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Author information

Authors and Affiliations

  1. Surgical Outcomes and Applied Research Program, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 E. 17th Avenue, C-310, Room 6602, Aurora, CO, 80045, USA

    Helen J. Madsen, William G. Henderson, Adam R. Dyas, Michael R. Bronsert, Kathryn L. Colborn, Anne Lambert-Kerzner & Robert A. Meguid

  2. Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA

    William G. Henderson, Michael R. Bronsert, Anne Lambert-Kerzner & Robert A. Meguid

  3. Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA

    William G. Henderson & Kathryn L. Colborn

Authors
  1. Helen J. Madsen
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  2. William G. Henderson
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  3. Adam R. Dyas
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Corresponding authors

Correspondence to Helen J. Madsen or Robert A. Meguid.

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Conflict of interest

All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have approved the final article. The ACS-NSQIP and participating hospitals are the source of these data; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Informed consent

The Colorado Multiple Institutional Review Board determined this study exempt from review as it used publicly available deidentified data.

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Madsen, H.J., Henderson, W.G., Dyas, A.R. et al. Inpatient Versus Outpatient Surgery: A Comparison of Postoperative Mortality and Morbidity in Elective Operations. World J Surg 47, 627–639 (2023). https://doi.org/10.1007/s00268-022-06819-z

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  • DOI: https://doi.org/10.1007/s00268-022-06819-z

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