Skin and Soft Tissue Surgery in the Office Versus Operating Room Setting: An Analysis Based on Individual-Level Medicare Data

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BACKGROUNDThe relative volume of skin and soft tissue excision and reconstructive procedures performed in the outpatient office versus facility (ambulatory surgical center or hospital) differs by specialty, and has major implications for quality of care, outcomes, development of guidelines, resident education, health care economics, and patient perception.OBJECTIVETo assess the relative volume of surgical procedures performed in each setting (office vs ambulatory surgery center [ASC]/hospital) by dermatologists and nondermatologists.METHODSA cross-sectional analytical study was performed using the Medicare public use file (PUF) for 2014, which includes every patient seen in an office, ASC, or hospital in the United States billed to Medicare part B. Data were divided by physician specialty and setting.RESULTA total of 9,316,307 individual encounters were included in the Medicare PUF. Dermatologists account for 195,001 (2.1%) of the total. Dermatologists were more likely to perform surgical procedures in an office setting only (odds ratio 5.48 [95% confidence interval 5.05–5.95], p < .0001) than other specialists in aggregate.CONCLUSIONMore than 90% of surgical procedures are performed in an office setting, and dermatologists are more than 5 times as likely as other specialists to operate in an office setting.

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