Ambulatory surgery centers can improve hospital efficiency and outcomes in total joint arthroplasty (TJA), even as hospital-patient acuity rises, a new study has found.
The study – published in JAAOS Global Research & Reviews – analyzed 7,775 total hip and knee arthroplasties performed at a single hospital from 2018 to 2023. Researchers compared hospital-based TJA cases before and after the launch of a joint-venture ASC affiliated with the hospital, to assess how shifting healthier patients to the ASC affected the hospital’s remaining patient population and quality metrics.
After the ASC opened, hospital-based TJA patients were notably older, with an average age of 69.8 versus 66.8 years prior to the ASC’s opening. They also had higher ASA scores and were more likely to have entered through the emergency department or undergone revision procedures.
“The acuity of TJAs performed in the hospital increased, but outcomes remained consistent or improved,” researchers wrote.
And following the ASC’s opening, same-day discharges from the hospital more than doubled, rising from 6.3% to 16.5%, while discharges to skilled nursing facilities dropped from 9.3% to 6.9%. Total charges per hospital case also decreased.
The results can be attributed to the institution’s long-standing implementation of clinical care pathways and enhanced recovery protocols, which were standardized across both the ASC and hospital settings, researchers wrote.
“The use of a coordinated clinical TJA pathway can potentially mitigate the adverse effects of increased hospital acuity after shifting appropriate patients to ASCs,” researchers wrote.
For ASC operators, the study supports the idea that lower-risk patients can be shifted to ASCs safely and effectively without compromising hospital quality, and that aligning perioperative care protocols across settings can help maintain good outcomes.
“Evaluation of a program’s LOS across hospital and ambulatory sites will become an increasingly important indicator of efficiency,” researchers wrote, adding that as ASC programs mature, hospitals should expect a higher concentration of complex, high-acuity TJA cases.
As TJA volumes rise and more procedures shift to outpatient settings, ASC-hospital collaboration will be increasingly important, researchers wrote.
“An institution with a well-established TJA pathway can overcome the increased hospital acuity following the opening of an affiliated ASC,” they wrote.
