Nashua Ambulatory Surgical Center (NASC) in Nashua, New Hampshire, has expanded its services to include total joint surgery, beginning with its first total shoulder replacement.
This successful surgery marks the launch of NASC’s total joint program, which will reportedly grow to include total hip and knee replacements in early 2026.
“The motivation to bring total joint surgery to NASC is to provide high-quality, cost-effective outpatient care with a focus on patient safety, comfort and faster recovery times,” Meredith Sterling, nurse administrator with the organization, told Ambulatory Surgery Center News. “The decision is driven by national trends, medical advancements and a surgeon’s desire to provide a more personalized patient experience compared to a hospital setting.”
Sterling said NASC’s orthopedic surgeons prefer operating at the ASC due to a controlled, efficient environment where teams are specialized and familiar with their preferences. The proximity of the surgeons’ offices in the building next door also adds convenience.
“The goal of the expansion is to increase case volume and improve the financial health and long-term growth of the center by tapping into a growing market for outpatient total joint replacements,” she said.
NASC, a state-licensed and Accreditation Association for Ambulatory Health Care-accredited outpatient surgical center, offers advanced, patient-centered care across multiple specialties in a modern facility.
NASC chooses new specialties by considering a range of clinical, financial and market factors, with surgeons’ owners’ input as a primary driver, given their direct involvement in operations and case volume generation, Sterling explained.
As the only independent ASC in Nashua, NASC’s surgeon-owners have a direct say in governance and clinical input, aligning high-quality care with strong financial performance and strategic growth. Their collective desire and influence heavily guide decisions to introduce new procedures or specialties that align with their practice areas and the facility’s model.
Launching a new program
Launching an ASC total joint program requires careful planning around financial viability, operational readiness and a comprehensive patient care pathway, according to Sterling.
The key considerations and challenges involve ensuring adequate surgical volume, securing favorable insurance contracts, making necessary physical space and expensive equipment purchases, and developing robust protocols for patient education and post-operative care.
Establishing a new surgical service in a modern outpatient facility is a complex project that involves strategic planning, facility and equipment setup, staffing, training and operational readiness.
Securing approval and support from key stakeholders, including surgeons, leadership staff, finance and the board, was critical, Sterling noted.
“We revamped our sterile processing department to include larger sterilizers and installed [reverse osmosis] water to feed our sterilizers, which is the gold standard,” she said. “To help with cost savings and improved operational efficiencies, we implemented vendor, instrument tray and equipment standardization. This simplifies the sterilization process, reduces inventory costs and minimizes setup time.”
Additionally, Sterling said NASC trained and ensured it had a full complement of skilled staff, including surgeons, anesthesia providers, nurses, surgical technologists and sterile processing technicians.
“Our comprehensive training program covered new equipment, standardized procedures and infection control protocols,” she said. “All staff demonstrated competency before the first case, and then we went live with our first total shoulder, which was a success.”
Dr. Daniel P. Bouvier performed the first total shoulder replacement surgery at NASC on Nov. 5
Bouvier, affiliated with New Hampshire Orthopedic Center, is a board-certified orthopedic surgeon specializing in minimally invasive joint procedures.
When considering performing NASC’s first total shoulder replacement, Bouvier said he wanted to ensure he had the proper equipment — joint replacement trays and suitable sterilizing equipment — to handle them, and to plan logistics, such as educating and training the perioperative nursing staff on protocols both before and after the operation.
“Having the staff at NASC visit our Bedford Ambulatory Surgical Center to observe the joint replacements there, to train and to become familiar with the steps necessary to streamline the surgical process was crucial,” Bouvier told ASC News. “Having a joint replacement program in place at the Bedford facility allowed the NASC staff to become comfortable, and once we had the materials and logistics in place, we were ready to proceed.”
Sterling said the total joint program at NASC will evolve to bring total knee and hip surgeries to the center next year.
In the meantime, the ASC’s focus will be on shifting more procedures to the outpatient setting, incorporating advanced technologies, and improving patient education and care coordination.
“With increased volume at our ASC, we would like to expand to open a third operating room and adopt new technology, such as robotic surgery,” Sterling said.
