Lower adverse event and mortality rates in physician offices compared with ambulatory surgery centers: a reappraisal of Florida adverse event data.
BACKGROUND
A recent study using Florida adverse event data found an increased risk of mortality in offices as opposed to ambulatory surgical centers. A major limitation of Florida adverse event data is the lack of uniform collection of the number of cases performed.


OBJECTIVE
The objective was to reassess the risk of mortality from physician office and ambulatory surgical center procedures using improved estimates of the numbers of cases performed in these settings.


METHODS
Adverse incident reports from March 2000 to March 2003 were obtained from the Florida Board of Medicine. We used data from the National Ambulatory Medical Care Survey and from the Medicare Current Beneficiary Survey to estimate the number of office procedures in Florida for both the general and the Medicare populations. The number of procedures performed and the number of deaths in ambulatory surgical centers was obtained from the Florida Agency of Healthcare Administration for the years 2000 through 2002. These data were used to calculate adverse event and mortality rates.


RESULTS
For physician offices, the adverse event rates and mortality rates calculated per 100,000 procedures from National Ambulatory Medical Care Survey data were 2.1 and 0.41, respectively, and 0.24 and 0.10 using Medicare Current Beneficiary Survey data. For ambulatory surgical centers, the mean adverse event rate was 4.4 and the mean mortality rate was 0.90.


CONCLUSIONS
Florida's adverse event data do not show higher adverse event rates in physician offices compared with ambulatory surgical centers. Incident reporting and public availability of incidents are important, as is standardization of reporting rules for both adverse events and number of procedures performed in different settings.
Venkat
Arun P
AP
Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA.
Coldiron
Brett
B
Balkrishnan
Rajesh
R
Camacho
Fabian
F
Hancox
John G
JG
Fleischer
Alan B
AB
Feldman
Steven R
SR
D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000401:mortality / Q000592:standards*; D016208:Databases, Factual; D005431:Florida / Q000453:epidemiology; D006801:Humans; D019300:Medical Errors / Q000706:statistics & numerical data*; D006278:Medicare; D010824:Physicians' Offices / Q000592:standards* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D013531:Surgicenters / Q000592:standards* / Q000706:statistics & numerical data