Cost Savings From Utilization of an Ambulatory Surgery Center for Orthopaedic Day Surgery

Fabricant, Peter D.; Seeley, Mark; Rozell, Joshua C.; Fieldston, Evan S.; Flynn, John M.; Wells, Lawrence; Ganley, Theodore J.

doi:10.5435/jaaos-d-15-00751

Cited by 82 publications

(59 citation statements)

References 25 publications

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“…The refinement process takes time, since there is an incentive for better outcomes and greater efficiency. [3] The findings of the current study are corroborated by previous studies showing that surgery time is shorter when the procedure is performed in the outpatient setting than the inpatient setting. [3,5] Additionally, most freestanding ambulatory surgery centers are at least partially owned by physicians who perform surgeries at the facility.…”

Section: Discussionsupporting

confidence: 88%

“…This may be an area of future research to identify the granular differences, if any exist, in the surgery process in order to improve efficiency. [3] Patients having a UKA in the inpatient setting will spend approximately 78 minutes more time in PACU than their outpatient counterparts. Although this was not statistically significant, this is clinically and financially significant.…”

Section: Discussionmentioning

confidence: 99%

“…[14,15] With outpatient services, hospitals are able to save on costs, due to less invasive procedures and reduced dependency on inpatient resources. [3] With the outpatient setting as a viable option, patients are discharged for recovery to their homes, instead of being admitted to the hospital. Nevertheless, given the wide variation in how procedures are performed and the supportive care that procedures require, transitioning to the outpatient setting is not a simple task that can be done on a large scale, especially given the current systems in place.…”

Section: Discussionmentioning

confidence: 99%

“…Significant factors in the inpatient setting may include overhead of the entire hospital, staffing, equipment, and infrastructure costs. [3] The costs in the outpatient setting are reduced because there is less overhead associated with performing the surgeries, which in turn leads to less cost shifting. [4] The process time of surgeries has not been widely compared between the outpatient and inpatient setting.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Unicondylar knee arthroplasty in the inpatient vs. outpatient setting: Impact on process time

Zeini

Gabriel

Liu

et al. 2018

JHA

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Objective: There is a lack of research on the impact of transitioning inpatient procedures to the outpatient setting, specifically on process time. Unicondylar knee arthroplasty (UKA) presents an opportunity for further investigation as it is already in the early stages of transitioning to the outpatient setting.Methods: This study analyzed the medical records of 1,075 patients who received UKA from a single surgeon (400 in the outpatient setting and 675 in the inpatient setting). Time in Pre-Op, surgery time, and time in post-anesthesia care unit (PACU) were recorded and compared between inpatient and outpatient settings using Ordinary Least Squares Regression models.Results: Outpatient UKAs outperformed inpatient UKAs across two out of three process time variables even after controlling for comorbidities, social history, demographics, and surgery related characteristics. Actual surgery time was no different between the two settings.Conclusions: This study demonstrated that UKA performed in the outpatient setting is associated substantial time savings preoperatively and postoperatively compared with cases performed in the inpatient setting. More research is needed to compare other outcome measures such as patient outcomes of UKA between the two settings. Implications beyond time savings should consider supply and human resources costs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Unicondylar knee arthroplasty in the inpatient vs. outpatient setting: Impact on process time

Zeini

Gabriel

Liu

et al. 2018

JHA

View full text Add to dashboard Cite

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“…Moreover, private payers are emphasizing lower cost sites of care as studies continue to demonstrate equivalent or improved outcomes in the outpatient setting at substantially lower cost to the health system [20,21].…”

Section: Discussionmentioning

confidence: 99%

Outpatient total knee arthroplasty: is it economically feasible in the hospital setting?

et al. 2020

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a b s t r a c tBackground: With the removal of total knee arthroplasty (TKA) from the Medicare inpatient-only list, outpatient TKA can now be offered, irrespective of payer, in multiple sites. We compared time-and costeffectiveness of outpatient TKA performed in a hospital outpatient department (HOPD) to that at an inpatient academic medical center (AMC). Methods: We reviewed all outpatient TKAs performed at our AMC and our HOPD from August 2018 to July 2019. Time efficiency by phase of care was determined, and cost data were obtained from the hospital financial department. Patient selection for outpatient surgery was identical for each site of care. Results: We identified 21 knees that had surgery at the HOPD and 65 knees that had surgery at the AMC. Demographics were similar in both groups. The AMC group had significantly longer in-facility to operating room (D (difference) ¼ 33.5 minute, P ¼ .0003), postanesthesia care unit to discharge (D ¼ 158.8 minute, P < .0001) and in-facility to discharge (D ¼ 199.3 minute, P < .0001) time periods compared to the HOPD group. The HOPD was significantly more cost-effective for the preoperative period (D ¼ $75.7, P < .0001), postoperative period (D ¼ $315.1, P < .0001), and total cost (D ¼ $241, P < .0001). Conclusions: Outpatient TKAs performed in an HOPD spend significantly less time within the facility than the ones performed in an AMC and cost significantly less. It is expected that approval of Medicare TKAs at ambulatory surgery centers will further improve cost and efficiency.

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Trends in Use of Ambulatory Surgery Centers for Cataract Surgery in the United States, 2001-2014

et al. 2018

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IMPORTANCE Cataract surgery is commonly performed at ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). These venues differ in many ways, including surgical efficiency, patient throughput, patient safety, and costs per surgery. OBJECTIVE To determine trends in use of ASCs and HOPDs for cataract surgery from 2001 to 2014 and factors affecting the site of surgery. DESIGN, SETTING, AND PARTICIPANTS This retrospective longitudinal cohort analysis involved individuals 40 years and older who underwent cataract surgery between January 2001 and December 2014 from a nationwide US managed care network. Data were analyzed from February 2016 to February 2017. MAIN OUTCOMES AND MEASURES We identified all enrollees who underwent cataract surgery and determined whether the surgery was performed at an ASC or HOPD. We calculated the proportion of surgeries performed at each site each year from 2001 to 2014. Multivariable logistic regression identified characteristics of enrollees who had cataract surgery at an ASC vs a HOPD. We also assessed geographic variation in the proportion of cataract surgeries performed at ASCs in 306 communities throughout the United States. RESULTS Of the 369 320 enrollees included in this study, 208 319 (56.4%) were female, and the mean (SD) age was 66.3 (10.4) years. All enrollees underwent cataract surgery (531 325 surgeries) from 2001 to 2014. Of these, 237 046 (64.2%) underwent cataract surgery at an ASC. The proportion of cataract surgeries performed at ASCs increased from 43.6% in 2001 to 73.0% in 2014. Compared with enrollees with incomes less than $40 000, those with incomes greater than $100 000 were 20% more likely to undergo cataract surgery at an ASC (odds ratio, 1.20; 95% CI, 1.12-1.29). Enrollees with better overall health were no more likely to undergo cataract surgery at an ASC (odds ratio, 1.00; 95% CI, 0.99-1.00) than at an HOPD. Enrollees who lived in communities without certificate of need laws were more than twice as likely to have surgery at an ASC (odds ratio, 2.49; 95% CI, 2.35-2.63). The proportion of cataract surgeries performed at ASCs from 2012 to 2014 varied considerably, from 1.6% in La Crosse, Wisconsin, to 98.8% in Pueblo, Colorado. CONCLUSIONS AND RELEVANCE We observed a large shift in the site of cataract surgery from HOPDs to ASCs from 2001 to 2014. Future research is needed to assess the effect of this transition in site of surgical care on patient access to surgery, surgical outcomes, patient safety, and societal costs.

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Cost Savings From Utilization of an Ambulatory Surgery Center for Orthopaedic Day Surgery

Abstract: Level II.

Cited by 82 publications

References 25 publications

Unicondylar knee arthroplasty in the inpatient vs. outpatient setting: Impact on process time

Unicondylar knee arthroplasty in the inpatient vs. outpatient setting: Impact on process time

Outpatient total knee arthroplasty: is it economically feasible in the hospital setting?

Trends in Use of Ambulatory Surgery Centers for Cataract Surgery in the United States, 2001-2014

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