title: Outpatient cholecystectomy at hospitals versus freestanding ambulatory surgical centers.
abstract: BACKGROUND
  Because of safety concerns, some payers do not reimburse for laparoscopic cholecystectomy performed in freestanding ambulatory surgical centers (ASCs). This policy has been controversial because of increasing competition between ASCs and hospitals for low risk surgical patients.
  
  
  METHODS
  We performed a retrospective cohort study of patients undergoing elective outpatient laparoscopic cholecystectomy in the state of Florida in 2002 and 2003 (n=40,040), using the Agency for Healthcare Research and Quality State Ambulatory Surgery Database. Patients treated in hospitals and ASCs were compared with respect to patient characteristics, charges, outcomes, and processes of care.
  
  
  RESULTS
  For both hospital-based and ASC-based laparoscopic cholecystectomy patients, greater than 99% were successfully discharged home, and there were no reported deaths. Compared with those treated in hospitals, patients in ASCs had a higher rate of intraoperative cholangiogram (39% versus 36%, p=0.008). There was no difference in the proportion of procedures converted to open cholecystectomy. ASC-based patients were slightly younger (mean age 45 years versus 49 years, p < 0.001), were less often diagnosed with acute cholecystitis (4.8% versus 8.3%, p < 0.001), and had fewer comorbidities on average than hospital-based patients, but both cohorts had few comorbidities overall (99% had Charlson scores of 0 or 1). ASC patients were more likely to be Caucasian (86% versus 75%, p < 0.001) and were more likely to have private insurance (92% versus 67%, p < 0.001). For patients who had ambulatory laparoscopic cholecystectomy as the only procedure, the median charges were $6,028 at ASCs, compared with $10,876 at hospitals.
  
  
  CONCLUSIONS
  In a population of slightly younger, healthier patients, laparoscopic cholecystectomy in freestanding ASCs appears to be performed safely and with substantially lower charges than in hospitals.
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paquette
authors.forename: Douglas
authors.initials: D
authors.lastname: Smink
authors.forename: Samuel R G
authors.initials: SR
authors.lastname: Finlayson
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000191:economics*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000191:economics*; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D005431:Florida; D005705:Gallbladder Diseases / Q000601:surgery; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D018579:Patient Selection; D012189:Retrospective Studies; D013531:Surgicenters; D016896:Treatment Outcome