Defining Outpatient Surgery: Perspectives of Surgical Staff in the Veterans Health Administration.

Background: A standard definition of outpatient surgery that is aligned with the perspective of surgical providers is needed for consistent and focused surgical quality measurement. We sought to clarify the procedure characteristics that define outpatient surgery through a consensus process with multidisciplinary surgical staff from the Veterans Health Administration (VA).

Methods: A convenience sample of 14 VA surgical staff participated in three rounds of a modified-Delphi process. They rated procedure characteristics (e.g., settings, providers, anesthesia, and incision type) to include in a definition of outpatient surgery for adverse event detection.

Results: Consensus was reached on 63% of the criteria. Participants agreed to exclude procedures performed by gastroenterologists; in contrast, they agreed to retain endoscopic procedures. There was inter and intra-variation between rounds but no pattern based on staff discipline.

Conclusions: Contradictory responses and the lack of consensus on several key questions revealed few procedure characteristics that surgical staff agreed could be used to define outpatient surgery. Our findings suggest that contextual factors associated with specific procedures may be important; future efforts to define outpatient surgery should consider both the characteristics of the procedure and the procedure itself.