Comparing definitions of outpatient surgery: Implications for quality measurement

• Published in: The American journal of surgery Vol. 214; no. 2; pp. 186 - 192
• Main Authors: Mull, Hillary J, Rivard, Peter E, Legler, Aaron, Pizer, Steven D, Hawn, Mary T, Itani, Kamal M.F, Rosen, Amy K
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2017; Elsevier Limited
• Subjects: Aged; Ambulatory surgery; Ambulatory Surgical Procedures - adverse effects; Ambulatory Surgical Procedures - standards; Clinics; Codes; Data warehouses; Female; Government programs; Health care; Health care industry; Health care policy; Humans; Male; Measurement; Measurement methods; Medicaid; Medicare; Mortality; Outpatient care facilities; Patient safety; Quality; Quality assessment; Quality Assurance, Health Care; Quality control; Quality improvement; Quality measurement; Safety programs; Software; Studies; Surgeons; Surgery; Surveillance; Terminology as Topic; Veterans; Measurement; Patient safety; Quality improvement; Ambulatory surgery; Quality measurement; Veterans
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2017.01.021

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.