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Ambulatory Surgery Centers (ASCs) have seen considerable growth in the outpatient surgery market in the U.S.

While the relationship between hospital surgical volume and patient outcomes has been well studied, finding higher operating volume has been associated with better patient results, there was previously no evidence to demonstrate the relationship between the surgical volume at ASCs and the quality of surgical care.

That recently changed. Dr. Siddharth Jain of the Yale New Haven Hospital Center for Outcomes Research and Evaluation and colleagues examined that relationship in a 2024 study.

New Haven, Connecticut-based CORE is a national outcomes research center working on select projects designed to assess health care quality, evaluate clinical decision-making and compare the effectiveness of specific health care interventions.

The study focused on patients aged 66 and above who underwent various procedures, including orthopedic and general surgeries, and skin and soft tissue procedures at ASCs. It aimed to investigate whether low-volume ASCs had higher rates of revisits after surgery compared to higher-volume ASCs, particularly among patients with multimorbidity.

“It is important to recognize that the study only looked at Medicare’s volume of specific procedures,” Jain told ASC News. “Given that the Medicare population has more comorbidities, it was important to determine if surgery centers with fewer Medicare patients undergoing procedures studied had similar safety profiles.”

The study found that those treated at low-volume ASCs were more likely to return within seven days of surgery than those treated at higher-volume ASCs. This relationship was stronger for patients receiving orthopedic surgeries and those with multimorbidity.

Further analysis revealed that a slight bias in patient characteristics could not explain the higher rate of revisits in low-volume ASCs for multimorbid patients.

While the reasons behind a patient’s choice of a small or large ASC remain unclear, these findings align with the long-standing association between higher hospital operating volume and better patient outcomes.

The greater team experience – including nursing, anesthesia and surgery – that higher volume affords could be responsible for similar benefits occurring at higher-volume ASCs, suggesting a potential avenue for improving patient outcomes in these settings.

As the number of older individuals with multimorbidity in the U.S. continues to increase, surgery for older patients is increasingly being performed at surgery centers.

Therefore, these findings are significant as they highlight the need for healthcare providers to consider the volume of procedures performed at an ASC when deciding where to perform surgeries for patients with multimorbidity.

“Older patients with multiple chronic conditions should discuss with their surgeon the optimal location of care,” Jain explained. “Patients with comorbidities need to understand if the team taking care of them has the requisite knowledge and resources to care for them in the chosen location.”