After Joan Rivers, Should Patients Worry About Ambulatory Surgical Centers?

The incident that led to Joan Rivers’ heart attack occurred at what is called an ambulatory surgical center. Rivers’ procedure was an endoscopy, considered a routine procedure, to look at her vocal chords. During this outpatient surgery at Yorkville Endoscopy Center on August 28, she experienced cardiac arrest, and then was transferred by ambulance to Mount Sinai Hospital. She never regained consciousness; the hospital put her into a medically induced coma, and then later on life support before she died on September 4.

So far, there are no allegations of any wrongdoing. The state is investigating the incident and the center announced that its medical director was stepping down.

About 5,000 of these ambulatory surgical centers perform 23 million operations a year. The types of surgeries typically provided include endoscopy, colonoscopy, plastic surgery, removal of cataracts, and rotator cuff treatment.

In a piece on the topic, PBS Newshour interviewed Shannon Pettypiece of Bloomberg News. Pettypiece said there has been an increase in the use of surgical centers due to two factors:

• An increasing number of outpatient procedures – due to technological improvements, many procedures no longer require overnight hospital stays;
• Surgical centers charge less – much less. Sometimes they charge half as much as hospitals, probably because they don’t have the same overhead.

There is no evidence that surgical centers are less safe. A 2014 study published in the Health Affairs journal found that surgical centers tended to be more efficient overall, performing procedures on average in 32 minutes less time than hospitals.

The main difference from hospitals is that they don’t have intensive care units and emergency rooms. This means if complications do arise, patients have to be transported to a hospital. This leads experts to suggest that the primary question patients might want to ask a prospective surgical center is, how close is it to a hospital.

PBS Newshour refers to these facilities as outpatient medical centers, and emphasizes that they are typically owned by the doctors who operate there, rather than a large corporation or a nonprofit organization.

A concern that has been raised is the fact that doctors who share ownership in a surgical center refer more of their patients to their own surgical center rather than a hospital. Some wonder if this is a conflict of interest, but it could also be down to convenience or other factors.