The Effect of a New Ambulatory Surgery Center on Patient Acuity and Outcomes of Hospital-Based Total Joint Arthroplasty.

INTRODUCTION

Increasingly ambulatory surgery centers (ASC) are being used for patients undergoing total joint arthroplasty (TJA). The purpose of this study was to evaluate the effect of transitioning TJAs to a newly opened ASC on hospital quality measures of patients undergoing TJA in the hospital.

METHODS

A retrospective review of 7,775 patients undergoing TJA at a single hospital from January 2018 to October 2023 was performed. Overall, 4,554 cases who underwent TJA in the hospital from 2018 to 2019, before the ASC opening, were compared with 3,221 cases who underwent TJA in the hospital from 2022 to 2023, post ASC opening. Univariate statistics were used to examine differences between the groups.

RESULTS

Post ASC opening, patients were older (69.8 vs. 66.8 years; P < 0.001) and a higher percentage of patients had an American Society of Anesthesiologists score of 3+ (50.6% vs. 41.7%; P < 0.001). Post ASC opening, more patients had 0-day length of stay (16.5% vs. 6.3%; P < 0.001), fewer were discharged to skilled nursing facility (6.9% vs. 9.3%; P = 0.002), and total charge was lower ($12,095.6 vs. $12,555.1 USD; P = 0.001).

CONCLUSION

Following the opening of an ASC, the acuity of TJAs performed in the hospital increased, but outcomes remained consistent or improved. The use of a coordinated clinical TJA pathway can potentially mitigate the adverse effects of increased hospital acuity after shifting appropriate patients to ASCs.