I agree that there is a strong bias in play in hospitals to admit a patient rather than discharge them. The ease of bed access and the ingrained habit of admitting that is present at a full-service hospital is not present at an outpatient centre.
Our article clearly shows a low rate of unplanned admissions and readmissions in patients who receive their surgery at the Jim Pattison Outpatient Clinic and Surgery Centre (JPOCSC). As mentioned in the article, our criteria for eligibility for surgery at this centre are clearly defined (ASA 1 or 2 and no history of significant sleep apnea or adverse reactions to general anesthetic). When all variables are controlled, the admission rate at a hospital is significantly higher than at an outpatient centre.
In a previous article looking at the unplanned admission rate in breast reconstruction patients at JPOCSC and Surrey Memorial Hospital, a significant difference in admission rates was observed when all other patient variables were controlled for. The surgeons and anesthetists are the same individuals at both sites; therefore, the only remaining explanation is an institutional bias to admit. As the OR theatre staff is the same, this bias lies in the postanesthetic care units and day surgery units present in full-service hospitals. It is this inherent bias that our article hopes to change, showing that discharge rates for planned day-care surgeries can be very high, and that planned outpatient surgery centres cannot have a bias to admit.
—Paul Oxley, MD, FRCSC
This letter was submitted in response to “Re: Canada’s largest purpose-built public day-care surgery centre.”
1. Oxley PJ, McNeely C, Janzen R, et al. Successful same day discharge after immediate post-mastectomy alloplastic breast reconstruction: A single tertiary centre retrospective audit. J Plast Reconstr Aesthet Surg 2020;73:1068-1074.
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