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May 18, 1984

The Need to Redefine Levels of Surgical Care

Author Affiliations

From the Department of Surgery, Durham County General Hospital, Durham, NC.

JAMA. 1984;251(19):2527-2528. doi:10.1001/jama.1984.03340430025022

IN RECENT years, both the number and variety of surgical procedures performed on nonhospitalized patients have increased markedly. These procedures are now being accomplished safely and without increased risk to patients. This method of avoiding hospitalization for patients with surgical problems of even intermediate magnitude is cost-effective, readily accepted by patients, and has improved the efficiency of surgical care delivery throughout the nation.

However, the classification and differentiation of these patients and the operations they receive are unclear, and much confusion results.1 We have an urgent need to redefine the levels of surgical care that we so competently provide.

Until recently, all surgical care was thought of as being provided either on an inpatient or outpatient basis, obviously determined by whether or not the patient was admitted to the hospital. In the last decade, major advances in surgical and anesthetic techniques, shorteracting anesthetic agents, the advent of milder yet adequate