onset and offset, which means we can give deeper anesthesia without
any lingering effects beyond the immediate post-operative period."
Patient satisfaction aside, Dr. Chadha believes surgery in outpatient
settings has eased the burden on the U.S. healthcare system. This
includes not only a reduction in costs associated with length of stay,
but also a drop in expenses tied to treating surgical site infections. He
3 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M a y 2 0 1 7
One factor that's driving more complex surgeries to the outpa-
tient setting: legislation that essentially lets ambulatory surgery
centers operate as extended-care facilities.
In Oregon, for example, House Bill 2664 (osmag.net/PoAaG9)
would let as many as 16 ambulatory surgery centers increase the
maximum allowable stay for patients to 48 hours, or even 52
hours, based on patient safety. The bill would essentially let
these surgical facilities offer more complex surgeries that
require longer recovery times, though it would also require them
to have 24-hour staffing.
anesthesiologist David Shapiro, MD, the past president of the
ambulatory Surgery Center association, says he expects more
"blurring of the lines" in the near future.
"We're starting to see this natural evolution," says Brian R.
Gantwerker, MD, the founder of The Craniospinal Center of Los
angeles (Calif.). "a lot of surgery centers have applied for 23-
hour admission status, and I believe we'll continue to see legisla-
tion allowing surgery centers to basically become mini-clinics."
What kind of effect will this trend have on hospitals? It's too
soon to tell, says Dr. Gantwerker, but, he says, it will be "inter-
esting" to watch. — Bill Donahue
BLURRING THE LINES
Extended Care Surgery Centers
