Quality of outpatient ambulatory surgical care: a systematic review and meta-analysis

Most surgical procedures in Australia are performed in the ambulatory (outpatient) setting; however, the quality of ambulatory surgical care is still poorly understood. Existing studies typically report outcomes for individual ambulatory surgical procedures, yet this limited scope does not capture the overall quality across the diverse range of ambulatory surgical procedures. We conducted a systematic review and meta-analysis to examine the safety and quality of ambulatory surgery, focusing on the facility-wide incidence of adverse clinical outcomes that occur within 30 days of surgery. We searched PubMed and Embase for studies published between January 2000 and July 2023, including studies reporting outcomes within 30 days following facility-wide ambulatory surgeries. Pooled estimates were calculated using the Freeman-Tukey double arcsine transformation. Publication bias was assessed through visual examination of funnel plots and Egger’s test for funnel plot asymmetry. From 4,298 records screened, we identified 30 studies encompassing 15,868,214 patients. Immediate hospitalisation was reported commonly (12 studies, pooled proportion 1.82%, 95% CI 1.1–2.71%), and 30-day hospitalisation was reported by nine studies (pooled proportion 2.88%, 95% CI 1.2–5.3%). Death and post-operative complications were infrequently reported. The most commonly reported causes of hospitalisations were surgical (34.4% of all hospitalisations, 95% CI 31.2–37.7%), organisational (26.0%, 95% CI 12.5–42.2%), and anaesthetic concerns (11.8%, 95% CI 9.6–14.2%). All pooled results showed a high degree of heterogeneity, reflecting differences in surgical cohorts and outcome definitions. Although ambulatory surgery appears to be associated with relatively low rates of conversion to inpatient hospitalisation or 30-day hospitalisation, these findings need to be interpreted with caution due to the heterogeneity in cohort and outcome definitions.