Ambulatory Surgery Center Research Articles

Outpatient Simultaneous Bilateral Unicompartmental Knee Arthroplasties: Safe with Positive Patient-Reported Outcomes

Outpatient Simultaneous Bilateral Unicompartmental Knee Arthroplasties: Safe with Positive Patient-Reported Outcomes

Reverse and total shoulder arthroplasty among Medicare patients in the ambulatory surgery center: a matched cohort study and retrospective review of 90-day complications

Reverse and total shoulder arthroplasty among Medicare patients in the ambulatory surgery center: a matched cohort study and retrospective review of 90-day complications

Racial disparities in mammogram rates across Texas in 2022: A statewide analysis.

e22511 Background: Breast cancer is the second leading cause of cancer death among women in the United States, and its incidence has been steadily increasing. Survival from breast cancer depends on the stage at diagnosis, and literature indicates that sociodemographic characteristics are associated with screening rates. Examining and understanding racial disparities is crucial to improving screening rates and reducing the burden of breast cancer in underserved populations. Methods: We used the Texas Outpatient Public Use Data File (TOPUDF), a publicly available dataset, to conduct a population-based cohort study of mammograms among females aged ≥ 40 years old at hospitals and ambulatory surgery centers during 2022. Mammograms were identified using Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. We queried the US Census Bureau, Population Division for age-grouped populations in 2022 stratified by gender, race, ethnicity, age group, and county of residence. We calculated age-adjusted outpatient mammogram rates per 1,000 population (AAMRs) using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mammograms. The statistical significance of the difference between racial groups AAMR were tested by comparing the intersection of 95% confidence intervals (95% CI) for the individual rates. Subgroup analyses included age group, rural vs urban residence, and public health region. Results: The female population aged ≥ 40 years during 2022 was 6,756,811, and a total of 1,425,988 mammograms were included in the study corresponding to AAMR 198.0 (95% CI 197.7 – 198.3). Asians were 7.0% of the target population, received 12.5% of mammograms, and had the highest AAMR 356.9 (95% CI 355.2 - 358.6). Whites were 48.8% of the target population, received 51.3% of mammograms, and had the second highest AAMR 205.4 (95% CI 205.0 - 205.9). Blacks were 12.3% of the target population, received 12.3% of mammograms, and had the third highest AAMR 196.7 (95% CI 195.7 - 197.6). Hispanics were 31.8% of the target population, received 23.8% of mammograms and had the lowest AAMR 149.3 (95% CI 148.8 - 149.8). The differences between racial groups were significant. On subgroup analyses using public health regions, Hispanics had the lowest AAMR in public health regions with large metropolitan centers but had substantial high rates in far western and far southern Texas. Asians had much higher AAMR in regions with large metropolitan centers. Conclusions: Significant racial disparities in mammogram rates exist among women in Texas. Hispanic women have the lowest AAMR, particularly in urban areas. To reduce the burden of breast cancer and improve screening rates in the community, there is a need for targeted interventions among underserved populations.

Children’s orthopaedics

The June 2025 Children’s orthopaedics Roundup360 looks at: Paediatric lateral condyle fractures with elbow dislocation: revisiting the Song classification of the most severe injuries; Surgical treatment of paediatric foot and ankle fractures in a freestanding ambulatory surgery centre is a safe, cost-effective alternative to a hospital; The effect of vitamin D on the speed and quality of paediatric fracture healing; A rapid MRI protocol for the evaluation of acute paediatric musculoskeletal infections eliminating contrast and decreasing anaesthesia, scan time, and hospital length of stay and charges; Transfer of paediatric supracondylar elbow fractures: a sensible thing to do?; Selective dorsal rhizotomy a viable long-term solution for cerebral palsy; Medial patellofemoral ligament from the parents’ perspective; Robots for screw placement in slipped capital femoral epiphysis.

Infection Prevention Assessment of Ambulatory Surgery Center Experiencing Extensive Outbreak of Nontuberculous Mycobacteria Septic Joint Infections, 2023–2024

Infection Prevention Assessment of Ambulatory Surgery Center Experiencing Extensive Outbreak of Nontuberculous Mycobacteria Septic Joint Infections, 2023–2024

Evaluating ASC-4 transfer rates in cataract surgery: insights into timing and causes of hospital transfers.

To describe the causes, timing, and contributing factors of direct hospital transfer cases from an ophthalmology-specific ambulatory surgery center (ASC) and to identify potential strategies for decreasing future transfers. A large ophthalmology surgery center in Des Moines, Iowa. Retrospective review. A retrospective chart review was performed on patients requiring hospital transfer from a Midwest ophthalmology-specific surgery center from March 2022 through July 2024. Variables reviewed included patient demographics, comorbidities, prior surgeries/surgical complications, results of preoperative physical examinations, type of surgery and anesthesia performed, the type and timing of each complication, and the reasons for transfer. Each transfer was assessed for its necessity, preventability, and outcome. 22 patients required hospital transfer of 24 960 admissions for a rate of 0.88 per 1000 admissions (95% CI, 0.58-1.33). Only 5 (23%) transfer cases were temporally related to anesthesia or surgery. The other 17 (77%) had concerns first noted before the induction of anesthesia. 9 (41%) of the surgeries were completed, 1 (5%) partially completed, and the remaining 12 (55%) surgeries were cancelled. The reasons for transfer were largely cardiac-related and/or blood pressure-related (18/22, 82%). Nearly a third of the transfers (7/22, 32%) were considered preventable. Hospital transfers from ASCs are rare, and all-cause hospital transfer rates may overestimate the true risk of ocular surgery. Most patients requiring hospital transfer were identified in the preoperative area. Greater attention to preoperative physical examination reports could potentially prevent some hospital transfers.

Risk stratification in hip and knee replacement using Artificial Intelligence: a dual centre study to support the utility of high-volume low-complexity hubs and ambulatory surgery centres

Risk stratification in hip and knee replacement using Artificial Intelligence: a dual centre study to support the utility of high-volume low-complexity hubs and ambulatory surgery centres

Surgical Safety Series in Gynecology: Uterine Perforation During Hysteroscopy in Ambulatory Surgery Centers

Surgical Safety Series in Gynecology: Uterine Perforation During Hysteroscopy in Ambulatory Surgery Centers

Comparing Complication Rates for Plastic Surgery Minor Procedure in Hospital and Out-of-Hospital Premises Clinics: A One Year Retrospective Review of 2739 Cases During COVID19 Pandemic.

Purpose: This study compares complication rates for minor reconstructive procedures done under local anesthesia in a hospital setting versus out-of-hospital premises (OHP) setting during the COVID-19 pandemic. If it could be shown that minor plastic surgeries have similar, if not reduced, complication types and frequencies, this would provide a strong rationale for more procedures to be delegated to non-hospital office settings. Not only would complication rates be lower for patients, resulting in improved quality of life and health outcomes, but there would be increased efficiency for minor plastic surgery procedures, improved patient wait times, and reduced burden on hospital resources to allow for accommodation of more complex and major procedures that cannot be performed elsewhere. Methods: This is a retrospective medical record review of patients who underwent minor plastic surgery procedures at a community hospital and OHP settings. All procedures were performed by the same plastic surgeon. Minor plastic procedures were defined as day procedures performed with only local anesthesia. Procedures were completed with field sterility (eg, use of drapes and sterile gloves) but not room sterility. A total of 2739 charts (537 hospital charts and 2202 clinic charts) from January 2022 to December 2022, were reviewed with annotation of patient demographics, procedure type, procedure site, follow-up dates, complications, and complication type, if any. Statistical analysis involving chi-squared tests was performed on anonymized data to primarily compare complication rates between the hospital and the outpatient clinic setting, as well as secondary comparisons of subgroups such as patients with diabetes and patients using blood thinners. Results: There was a 3.5% complication rate for the minor procedures in the hospital compared to 1.2% in OHP setting which was a statistically significant finding. Conclusion: There were fewer complications for patients undergoing minor reconstructive procedures in an outpatient clinic setting versus in-hospital, indicating the potential for delegation of minor surgeries to OHP clinics and ambulatory surgery centers.

Propofol Dexmedetomidine Total Intravenous Anesthesia with Tumescent Anesthesia in Aesthetic surgery.

Total intravenous anesthesia (TIVA) is commonly performed in ambulatory aesthetic surgery centers. The authors compared combination of TIVA and tumescent anesthesia for safety and efficacy in prolonged and successive multiple aesthetic procedures. A retrospective review of patients who underwent aesthetic surgery procedures under TIVA from 2016 through 2024 at the authors' aesthetic surgery center was conducted. Patients were included if they fulfilled ASA 1 or 2 staging, BMI < 45 and were of age between 12 and 80 years. Perioperative drug dosages, time under anesthesia and patient vitals were recorded. Of the 307 patients assessed, 301 completed surgery under TIVA and 6 were converted to GA. No major morbidity was recorded and all 307 cases were discharged from Anesthesia Recovery at 6 hours post-surgery. Average duration of anesthesia time was highest for lipoabdominoplasty (278 min, range 170-360 min). Average dose of tumescent anesthesia was highest in excisional body contouring (2967 ml). No surgical morbidity, e.g., skin necrosis, hematoma and blood transfusion, was reported. No anesthetic morbidity, e.g., deep vein thrombosis, fat embolism and lignocaine toxicity, was reported. Mean arterial pressure and SpO2 were maintained in safe normal range (70-100 mm Hg and > 95%, respectively) up to 6 hours postoperative. Aldrete score for postoperative recovery was > =9 at 10 min for 80% cases (n=245). The analysis of 307 total intravenous anesthesia with tumescent anesthesia cases demonstrated the overall safety and efficacy of the propofol-dexmedetomidine protocol under deep sedation. The study underscores the importance of complete preoperative assessments, vigilant anesthetist-guided drug infusions and monitoring for complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Maintaining Perioperative Normothermia in Patients Undergoing Ambulatory Surgery.

Inadvertent perioperative hypothermia occurs before, during, or after surgery when the patient's core body temperature is unexpectedly less than 36 °C (96.8 °F). Perioperative nurses at an ambulatory surgery center performed a quality improvement project involving prewarming with a forced-air warming device. The nurses reviewed 40 patient records for temperatures without prewarming and collected temperature data for 40 prewarmed patients. The nurses compared patient temperatures preoperatively, 30 minutes and one hour after anesthesia induction, and upon arrival in the postanesthesia care unit. The results for both groups at 30 minutes after induction were similar; however, at one hour after anesthesia induction, 38% of patients in the preimplementation group and 53% of patients in the postimplementation group were normothermic. Patients in both groups were normothermic upon arrival in the postanesthesia care unit. Education of staff members, patients, and patients' family members was key to the successful implementation of prewarming at the facility.

Findings of a Simple Institutional Screening Method in Ambulatory Pediatric Urology Procedures Amidst COVID-19 Surges in Iran

Background: The COVID-19 pandemic significantly affected global healthcare, particularly affecting surgical practices. During the initial stages, there was a widespread suspension of elective surgeries, which posed challenges to surgical care centers. Protocols were developed to resume surgical activities, but the risk of perioperative infections persisted. Pediatric urology faced unique challenges due to the lack of consensus on preoperative screening for ambulatory surgical centers. Objectives: The present study aimed to assess the efficacy of a simple institutional preoperative screening method for adverse outcomes in pediatric ambulatory urology procedures during the pandemic. A retrospective review of medical records from an outpatient ambulatory surgery center was conducted for this purpose. Methods: This retrospective cross-sectional study analyzed the effectiveness of an institutional preoperative screening method in reducing the incidence of symptomatic viral infections and non-surgical complications during six distinct pandemic peaks in pediatric urology surgery in Iran (February 2020 to March 2023). Results: Of the 825 patients, most were male (758 males vs. 67 females), with an average age of 27.7 ± 30.0 months. Elective surgery cancellations were low (2.4%), primarily due to fever, cough, and elevated inflammatory markers. Polymerase chain reaction (PCR) tests were positive in 0.24% of symptomatic patients, none of whom developed postoperative COVID-19. There were significant correlations between symptomatic patients and cancellations during COVID-19 peaks (P = 0.035). Conclusions: A combination of clinical and laboratory examinations may suffice for preoperative screening of pediatric urology surgical procedures during the pandemic. Routine PCR testing is not recommended in this setting and should be confined to symptomatic patients. Moreover, the reported experience may be useful in addressing potential future viral outbreaks.

Ureteroscopy at ambulatory surgery centers can be safe for select high-risk patients

PurposeTo determine whether unhealthy patients undergoing ureteroscopy at an ambulatory surgery center are at high risk of emergency post-operative transfer to an inpatient setting.MethodsRecords of 100 consecutive high-risk patients undergoing URS at a free-standing ambulatory surgery center (ASC) were reviewed. Patients were considered high-risk if their American Society of Anesthesiologists score (ASA) was ≥ 3. Perioperative risk was assessed using the Charlson Comorbidity Index (CCI) and the 5-factor Modified Frailty Index (mFI-5). Post-operative complications requiring emergent inpatient transfer on the day of surgery and complications within 30-days were recorded.ResultsThe median age for patients was 61.4 years (IQR: 54.7–68.4) and median BMI was 31.0 (IQR: 26.6–37.2). Common chronic illnesses were hypertension (74%), COPD (44%), diabetes (40%), and peripheral vascular disease (14%). All patients were considered high-risk by ASA score. By CCI, 28% of patients were high-risk, 23% were significant risk and 49% were mild risk, with median score of 3 (IQR 1–5). By mFI-5, 20% of patients were high-risk, with median score of 2 (IQR 1–2). No patient required emergent transfer on the day of surgery. Within 30 days postoperatively, 15 patients presented to the Emergency Department (ED) and 5 were admitted. mFI-5 and CCI were not predictive of ED visits.ConclusionSelected high-risk patients with unfavorable ASA, mFI-5, and CCI undergoing URS within an ASC are unlikely to require emergent, post-operative transfer to an inpatient facility.

Patient Preoperative Optimization: How to Do It and How to Be Paid for the Work.

Patient Preoperative Optimization: How to Do It and How to Be Paid for the Work.

HRS/ACC Scientific Statement: Guiding Principles on Same-Day Discharge for Intracardiac Catheter Ablation Procedures.

HRS/ACC Scientific Statement: Guiding Principles on Same-Day Discharge for Intracardiac Catheter Ablation Procedures.

Estimating 90th Percentile Times To Complete Multiple Pre-Operative Regional Anesthesia Procedures To Mitigate First-Case Start Operating Room Delays Caused by the Nerve Blocks.

When multiple patients are scheduled to receive regional blocks as part of their anesthetic, planning insufficient preoperative time can cause first-case operating room delays. Prediction of the time to perform multiple regional blocks depends on the probability distributions (e.g., 90th percentiles) of the procedure completion times. We tested hypotheses that, if supported, can be applied for planning how early regional blocks should start to mitigate late first-case of the day starts. The retrospective cohort study used data from two academic hospital surgical suites for all regional anesthetic procedures performed before the adult patients entered the operating room for a first-case of the day. Days with more total minutes of regional procedures had greater total lateness (negative if early) and tardiness (zero if early) of first-case starts for both suites (all four Bonferroni adjusted P < 0.0001). Increases in the numbers of procedures per day were not associated with significant differences in the 0.5 quantile (median) among days of the time per procedure for both the inpatient surgical suite (unadjusted P = 0.46) and the ambulatory surgery center (P = 0.14). The result supported our hypothesis that average times add arithmetically among procedures. Increases in the numbers of procedures per day were associated with significant decreases in the 0.9 quantile among days of the time per procedure for both the inpatient surgical suite (-0.83min per procedure, Bonferroni adjusted P < 0.0001) and the ambulatory surgery center (-0.90min per procedure, adjusted P = 0.0002). Because both slopes were reliably negative, the result supported our second hypothesis that the longest time to plan to complete a series of procedures (represented by the 0.9 quantile) is considerably less than as calculated by taking the sum of the individual procedures' 0.9 quantiles. Quantile regression or an Excel 365 formula based on the log-normal distribution for block times can consequently be used to predict the time when anesthesiologists should start procedures and have a low risk of causing first-case start delays. For example, with 7 blocks, the sum of individual 0.9 quantiles would suggest that the anesthesiologist needs to start ≈35min earlier than necessary based on the 0.9 quantile. Sufficient time can be planned to perform multiple procedures before the first-case of the day starts using quantile regression or an Excel formula. The estimated times are briefer than the sum of the 0.9 quantiles, but longer than the sum of the 0.5 quantiles.

Statistical Power Analyses for Quantifying the Similarity of Categories of Surgical Procedures Among Pairs of Hospitals and Ambulatory Facilities.

Mixed methods are often used to understand organizational associations and differences. For example, one might compare hospitals and ambulatory surgery centers, each described by its relative distribution of cases' categories of surgical procedures, quantified using anesthesia Current Procedural Terminology (CPT) codes. The similarity of these distributions between facilities can be assessed using a metric akin to a correlation coefficient. Conceptually, identifying similar organizational pairs is feasible, as most U.S. states and Canadian provinces maintain databases containing such administrative data. However, research proposals based on mixed methods may be hindered by the lack of statistical power analysis to determine whether the quantitative phase will yield a sufficient number of similar facilities to support the qualitative phase (i.e., interviews). Data were obtained from the American Society of Anesthesiologists' National Anesthesia Clinical Outcomes Registry. The dataset included 12,902,159 cases across 272 procedure categories, performed at 2442 facilities in the United States. The similarity index between facilities ranged from 0 (no overlap in surgical procedures) to 1 (identical distribution of procedures). Values ≥0.80 were considered indicative of high similarity. We estimated the proportion of highly similar facility pairs (similarity index ≥0.80) with low standard errors (<2.0). For each pair, we computed the inverse of the standard normal distribution based on the ratio of the difference from 0.80 to the standard error. The average of these values yielded the mean prevalence of high similarity. This estimated prevalence was then used in power analyses based on the binomial distribution. Only 1.00% (standard error: 0.01%) of facility pairs had a similarity index ≥0.80. Based on this prevalence, a database would need to include just 38 organizations to have an ≥80% probability of identifying at least five highly similar pairs for interviews. With data from 67 organizations, there would be a ≥95% probability of identifying at least 15 pairs. In contrast, consider an individual organization deciding whether to (a) join a consortium to identify similar organizations for shared strategies, or (b) invest in analysts to explore mandatory state or provincial databases for such purposes. Unless more than 1,000, and ideally more than 2,100, organizations contribute data, the probability of finding multiple highly similar peers may be low. Investigators can expect a high probability of obtaining sufficient organizational sample sizes for qualitative interviews when using large-scale databases. Although only a small fraction (approximately 1%) of organization pairs exhibit high similarity, the sheer number of potential pairs in state, provincial, and national databases compensates for this. However, for an individual organization seeking to identify peers for qualitative comparison, the chance of finding highly similar matches based on similar surgical procedures is extremely low, unless joining a very large data collective.

Association between surgeon procedure volume and reoperation rates for penile prosthesis implantation.

Prior studies have examined patient-specific predictors of reoperation following penile prosthesis (PP) insertion at the local and regional level, but little is known about patient factors and volume-outcome relationships at the national level. To assess the impact of patient characteristics and surgeon volume on reoperation rates following PP placement in a Medicare population. We utilized the 100% Medicare Standard Analytical Files to identify men aged ≥65years who underwent PP implantation between 2018 and 2021. Surgeon volume data were obtained from the Atlas All-Payor Claims dataset, and quartiles were calculated. Multivariable logistic regression was used to evaluate associations between reoperation rates, patient characteristics, and surgeon volume. The reoperation rate at 1-year post-implantation, the cause of reoperation, and factors associated with a higher reoperation rate. Among 8343 patients, 2.3% required reoperation at 90days and 6.3% at 1year. The most common comorbidities were diabetes (35.2%), cardiovascular disease (23.9%), Peyronie's disease (15.4%), and obesity (11.5%). Surgeon volume quartiles were calculated, with the highest-volume surgeons performing >31 cases annually versus <6 for the lowest quartile. Lower surgeon volume, older patient age, and smoking were associated with higher reoperation rates. Patients treated by top-quartile surgeons had 25%-28% lower odds of reoperation at 1year [OR 0.72; 95% CI 0.56-0.93; OR 0.75; 95% CI 0.59-0.97]. While higher surgeon volume was associated with lower reoperation rates, PP surgery remained safe across all volume levels. Strengths include the use of a nationally representative Medicare dataset and All-Payor volume-outcome analysis. Limitations include accuracy of claims data, inability to fully characterize reoperations, and lack of data for procedures performed in ambulatory surgery centers. In a nationally representative Medicare cohort, PP reoperation rates were low (6.3%), with mechanical complications accounting for 41% of reoperations (2.6% of the cohort). Higher-volume surgeons had lower reoperation rates, but outcomes remained acceptable across all volume levels, reinforcing the overall safety of the procedure.

Assessment of 90-Day Outcomes Following Total Joint Arthroplasty in Ambulatory Surgery Centers, Hospital Outpatient Departments, and Hospitals: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis.

Assessment of 90-Day Outcomes Following Total Joint Arthroplasty in Ambulatory Surgery Centers, Hospital Outpatient Departments, and Hospitals: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis.

Impact of a Pediatric Ambulatory Surgical Center on Surgery Resident Education.

Impact of a Pediatric Ambulatory Surgical Center on Surgery Resident Education.