Following the death of Joan Rivers in 2014, there have been increasing questions about the  safety of outpatient surgery centers. While hospitals are closely monitored and regulated by comprehensive state and federal authorities, surgery centers often operate in a gray area, amidst a patchwork of regulation. This does not mean they are unsafe – rather,  it is important to examine each facility’s record before making any decisions.

There has been dramatic growth in the industry, for reasons both clinical and financial.  More than two-thirds of operations performed in the United States now occur in outpatient centers, some of which are owned by hospitals. There was  a 41% increase in the number of centers that qualified for Medicare reimbursements between 2003 and 2011.  In 2006 nearly 15 million procedures were performed in surgery centers; by 2011 the number had risen to 23 million.

Patients say the  centers are cheaper, require less waiting and offer more personalized care. In addition, surgery centers are “a much more convenient, safe place to get quality health care,” said anesthesiologist David Shapiro, past president of the Ambulatory Surgery Center Association, a national trade group and member of the board of an organization that accredits surgery centers, enabling patients to avoid exposure to “the infections, chaos and delay” that he said pervade many hospitals.

Many surgery centers have agreements with local hospitals, and operate under many of the same standards. They will often decline patients with high risks of complications –  such as those with obesity, sleep apnea and breathing problems – and require them to have the procedure performed in a hospital.

Read more at Kaiser Healthcare.