Comparing definitions of outpatient surgery: Implications for quality measurement.

Mull HJ, Rivard PE, Legler A, Pizer SD, Hawn MT, Itani KMF, Rosen AK. Comparing definitions of outpatient surgery: Implications for quality measurement. American journal of surgery. 2017 Aug 1; 214(2):186-192.

Related HSR&D Project(s)

• CDA 13-270 – Development of an Adverse Event Surveillance System for Outpatient Surgery
• IIR 12-358 – Improving Surgical Quality: Risks and Impact of Readmission

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Abstract:

BACKGROUND: Adverse event (AE) rates in outpatient surgery are inconsistently reported, partly because of the lack of a standard definition of outpatient surgery. We compared the types and rates of surgical procedures defined by two national healthcare agencies: Health Care Cost Institute (HCCI) and the Healthcare Cost and Utilization Project (HCUP) and considered implications for quality measurement. METHODS: We used HCCI and HCUP definitions to identify FY2012-14 VA outpatient surgeries. RESULTS: There were six times as many HCCI surgeries as HCUP (6,575,830 versus 1,086,640). Ninety-nine percent of HCUP-defined surgeries were also identified by HCCI. More HCUP surgeries had higher average Medicare Relative Value Units then HCCI surgeries [5.3 (SD  =  4.4) versus 1.6 (SD  =  2.3) RVUs]. CONCLUSIONS: Rates and types of procedures vary widely between definitions. Quality measurement using HCCI versus HCUP may produce significantly lower AE rates because many of the surgeries included reflect low complexity and potentially low risk of AEs.