Variation in day surgery rates across Irish public hospitals

Highlights

• Day-surgery rates continue increasing over time but progress is slowing.
   
• Significant variation in day-surgery rates persist across hospitals.
   
• A large proportion of variation in day-surgery rates can be attributed to surgical-teams.
   

Abstract

The appropriate use of day surgery has been shown to provide the same or better outcomes for patients and to increase hospital efficiency. However, it is often underutilised, and rates can vary widely across hospitals. This study examines variation in day-surgery rates across Irish public hospitals and identifies the characteristics associated with these variations. Using patient-level administrative data on high-volume elective procedures, three-level logistic regression models are estimated which allow us to attribute variation in day-surgery rates to hospitals and surgical-teams. We find that day-surgery rates have increased in the last decade and vary substantially between hospitals for most procedures examined. Focusing on laparoscopic cholecystectomy, a key procedure targeted by policymakers, rates varied from 0% to over 90% across hospitals in 2019. We find that a substantial amount of variation in likelihood of day surgery is attributable to the surgical team (56.8%) with 37.8% attributable to the hospital. While there has undoubtedly been progress in the use of day surgery in Ireland there is still scope for improvement. A policy focus on encouraging and incentivising surgical team adoption of day surgery may be warranted, in addition to dedicated resources, and monitoring of day-surgery rate variation across hospitals.