Surgery’s silver lining: Better outcomes amid rising patient acuity
Article | September 3, 2025
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It’s easy to overlook the good news in healthcare amongst headlines highlighting workforce shortages, financial strain and sicker patients. But beneath these challenges lies a too-often unheralded feat: Hospitals are not only meeting the moment — they’re excelling.
A new report from the American Hospital Association, powered by Vizient data, reveals that hospitalized surgical patients in early 2024 were nearly 20% more likely to survive than expected compared with pre-pandemic benchmarks — progress that reflects both medical advances and operational resilience. Mortality risk is down, safety indicators are improving and hospitals are delivering better outcomes, all while caring for patients who are older and more complex than ever before.
“Hospitals are actually doing better with more complicated patients and on tighter margins,” said Vizient Chief Medical Officer David Levine. “That’s an amazing story.”
Why acuity is rising
There’s a paradox at the heart of today’s surgical landscape: Outcomes are improving even as patients grow more complex. According to the report, by 2035, quaternary patient days — which are those requiring the most intensive care — are projected to increase 19%, with most tied to surgical patients.
Several forces — many positive — are driving this shift:
- New medical advancements mean patients who once faced terminal diagnoses, such as cancer or heart failure, are now living long enough to require surgical interventions.
- Surgical innovation, including robotics and advanced imaging, has lowered procedural risk and expanded options for higher-acuity patients.
- Shifts in payment and patient preference are moving lower-acuity surgeries into outpatient settings, enabling hospitals to care for the sickest inpatients.
“Advancements in medicine mean patients who once wouldn’t have survived long enough for surgery are now living with chronic conditions — and often require complex surgical interventions,” Levine said.
This growing complexity raises an urgent question: How can hospitals sustain — and even build upon — these improvements in outcomes as patient acuity continues to climb? The following are strategies that health systems can deploy to better prepare for this new reality.
Increasing capacity: beds and ICUs
With surgical patients staying longer — on average nearly a day more than in 2019, according to the report — hospitals are grappling with capacity challenges. Saloni Jain, Vizient senior principal, intelligence, noted that capital planning must account for the new patient mix.
“Given that surgical patients are staying nearly a day longer than in 2019, flex spaces and convertible beds are crucial to ensuring hospitals can care for sicker patients with complex comorbidities without compromising outcomes,” Jain said.
Hospitals should also invest in remote monitoring and leverage system-wide ICU support to stretch critical care expertise. But these innovations will only work if paired with a workforce pipeline that prepares nurses and physicians earlier in their careers to manage high-acuity patients.
- Incorporate flex spaces and convertible beds into capital plans to accommodate rising patient acuity.
- Expand remote monitoring, both on-site and off-site, to extend ICU expertise across the system.
- Invest in nurse training pipelines so early-career nurses can enter critical care roles sooner.
- Leverage system-wide telemetry to connect community hospitals with academic center expertise.
Workforce strategies for a complex future
Caring for an increasing number of quaternary surgical patients requires more than expanded bed space — it demands highly trained teams. Levine underscored the importance of nurse-physician dyads, intensivists working alongside surgeons and early-career exposure to critical care.
At the same time, hospitals face an aging workforce alongside an aging patient population. Jain noted the need for novel care management models, including pairing surgical specialties with preventive or chronic disease services. For example, weight management may increasingly be embedded within orthopedic programs to reduce complications.
- Use a system-level strategy to determine which facilities should house specialized equipment, avoiding unnecessary duplication of expensive technology.
- Weigh ROI not just in financial terms but also in clinical outcomes and throughput efficiency.
- Align equipment decisions with the system’s identity and reputation, using select investments as strategic growth drivers.
Smart capital investments
System-level thinking is critical, but the question of where to invest in specialized surgical technology is becoming more nuanced. Robotics and advanced imaging can both improve outcomes and help recruit top clinicians. But Jain cautioned that equipment decisions aren’t just about outcomes — they also shape program reputation and workforce retention.
“Not every hospital needs every capability,” Levine said. “Strategy should dictate where investments go — whether that’s keeping orthopedic technology in community hospitals or concentrating quaternary services at academic centers.”
- Fully optimize nurse-physician dyads and expand intensivist models for surgical patients.
- Embed care planning at admission (or even pre-admission for elective surgeries) to coordinate aftercare early.
- Address the aging workforce by planning for retirements and expanding pipeline partnerships with nursing schools.
- Pair surgical specialties with preventive or chronic care programs (e.g., weight management + orthopedic surgery, diabetes management + vascular surgery) to reduce complications.
The role of analytics and OR efficiency
The AHA/Vizient report highlights that surgical patients are disproportionately complex compared with other inpatients. That makes analytics essential for managing portfolios, balancing acuity and optimizing workforce deployment.
“OR efficiency is a journey that touches everything — from pre-op checklists to operating room culture — and data is the backbone that empowers smarter decisions at every step,” Jain said.
Hospitals should use analytics to identify where surgical services should be concentrated; monitor quality, capacity and workforce performance in tandem; and improve OR efficiency through better scheduling, block time management and reduced cancelations.
- Use analytics to benchmark quality, capacity and workforce data for smarter surgical portfolio planning.
- Apply block time management to ensure unused OR time is repurposed efficiently.
- Standardize pre-op checklists, labs and surgical trays to reduce cancelations and variability.
- Focus on OR turnover times and on-time starts by using data to identify the root causes of delays.
- Strengthen OR culture and governance, recognizing that coordination is just as important as technology.
- Leverage artificial intelligence to predict case durations, optimize scheduling and identify early warning signs of complications.
Navigating policy and scenario planning
Policy pressures loom large, with the report highlighting how Medicare Advantage plans are contributing to longer hospital stays by delaying discharges. Looking ahead, additional payment shifts may push more procedures into outpatient settings.
Enter the importance of scenario planning.
“The smart strategy is to model the impact of potential payment or policy changes now, using those insights to realign service portfolios and capital investments long before the shifts arrive,” Jain said.
- Track payer-driven discharge delays (e.g., Medicare Advantage authorization timelines) to understand how blocked beds impact OR scheduling and surgical throughput
- Prepare for policies that may shift surgeries to outpatient settings by modeling scenarios to plan resource allocation in advance.
- Balance the advantages of telehealth and hospital-at-home programs against potential payment policy changes.
- Monitor potential Medicare and Medicaid reimbursement cuts and plan efficiency improvements.
The power of collaboration
Hospitals don’t have to go it alone. Levine pointed to growing collaborations between academic centers and community hospitals, as well as specialized partnerships that extend quaternary expertise into local markets.
“You don’t have to own everything,” Levine said. “Smart partnerships can ensure patients receive the right care, at the right place, while protecting system capacity.”
- Maximize system resources first: Distribute procedures to the most appropriate hospitals in your network.
- Form partnerships with academic centers Form partnerships with academic centers to extend quaternary expertise to community settings.
- Build joint programs for low-volume, high-complexity procedures to consolidate expertise.
- Create agreements with long-term acute care and rehab providers to ensure smoother patient transitions and preserve inpatient capacity.
Looking ahead: Better outcomes in a complex landscape
Despite rising surgical complexity, the outlook is far from bleak. In fact, hospitals are proving that higher acuity doesn’t have to mean worse outcomes.
“The fact that hospitals bridged the COVID divide and improved surgical survival rates by nearly 20% is an amazing feat—one that doesn’t always get the recognition it deserves,” Jain said.
The message is clear: Hospitals are adapting, innovating and collaborating in ways that are saving lives. As patient acuity continues to climb, these strategies — grounded in data, workforce planning and smarter capital investments — are essential to sustaining progress.