Ambulatory Surgical Center Research Articles

Utilization and Reimbursements of Primary Total Joint Arthroplasty in Ambulatory Surgical Centers: Analysis of Medicare Part A and B Databases

Utilization and Reimbursements of Primary Total Joint Arthroplasty in Ambulatory Surgical Centers: Analysis of Medicare Part A and B Databases

Outpatient Total Joint Arthroplasty at an Ambulatory Surgical Center: An Analysis of Failure to Launch

Outpatient Total Joint Arthroplasty at an Ambulatory Surgical Center: An Analysis of Failure to Launch

Are Commercial Value-Based Care Programs Still Viable for Hip and Knee Arthroplasty: An Analysis of a Single Institution.

Are Commercial Value-Based Care Programs Still Viable for Hip and Knee Arthroplasty: An Analysis of a Single Institution.

B-91 | Interventional Cardiologists’ Perspectives of Percutaneous Coronary Intervention at Ambulatory Surgical Centers

B-91 | Interventional Cardiologists’ Perspectives of Percutaneous Coronary Intervention at Ambulatory Surgical Centers

Implementation of a multidose ophthalmic medication policy change at a large health system.

Implementation of a multidose ophthalmic medication policy change at a large health system.

Evaluating Nanopore Sequencing as a Respiratory Virus Diagnostic Tool for the Prehospital Setting.

Upper respiratory tract infections are a strain on military that results in lost duty days and an overall reduced readiness of the force. Improved diagnostic testing would enable better force health protection measures and earlier treatment of illness. Lightweight portable devices are preferred for diagnostic testing in austere environments where they are sometimes needed during military deployment. Current diagnostic testing is targeted to specific pathogens despite multiple pathogens that present with similar symptoms. In practice the pathogens that cause upper respiratory tract infections often go unidentified, which could be improved using agnostic or semi-agnostic diagnostic testing. Here, we performed an evaluation of shotgun metagenomic sequencing using the Oxford Nanopore Technologies (ONT) Rapid Sequencing Kit as a method for diagnostic testing of upper respiratory tract infections. This sequencing library preparation kit was chosen because of its ease of use and compatibility with the ONT MinION, a lightweight portable sequencer. Samples from patients with symptoms of upper respiratory tract infections were collected at Wilford Hall Ambulatory Surgical Center under an approved IRB protocol. Nasal rinse samples from 59 study participants were tested using the BioFire FilmArray Respiratory 2.1 Panel as well as shotgun metagenomic sequencing using ONT Rapid Sequencing Kit and ONT R9.4.1 flow cells. A mixture of various viral pathogens was present among the 59 samples used in this study. We observed high specificity and modest sensitivity to detect the identified pathogens using shotgun metagenomic sequencing. Shotgun metagenomic sequencing detected additional pathogens that were missed by the BioFire FilmArray Respiratory 2.1 Panel, which are discussed. Lastly, we observe modest evidence of nonuniformity of the proportion of reads belonging to the pathogen during the duration of sequencing runs, which has implications for improving sensitivity by increasing the amount of sequencing performed. Overall, ONT Rapid Sequencing Kit combined with alignment to a known panel of pathogens has shown great potential utility in our hands for quickly and accurately identifying viral respiratory pathogens. This, combined with its ease of use and portability, makes it a great candidate for further research and development toward a deployable agnostic diagnostic testing platform.

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.

Solid Waste and Associated Environmental Impact of WALANT Carpal Tunnel Release Performed Across Three ClinicalSettings.

Solid Waste and Associated Environmental Impact of WALANT Carpal Tunnel Release Performed Across Three ClinicalSettings.

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

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

2028 Propensity Matched Analysis of Hospital Outpatient Department versus Ambulatory Surgical Center Outcomes in Elective Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

2028 Propensity Matched Analysis of Hospital Outpatient Department versus Ambulatory Surgical Center Outcomes in Elective Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

Outcomes of ambulatory versus outpatient hospital-based surgical center shoulder arthroplasty: complications, readmissions, and charges.

The rising demand for primary total shoulder arthroplasty (TSA) has spurred interest in comparing the safety and cost-effectiveness of outpatient TSA in ambulatory surgical centers (ASCs) versus hospital-based centers (HSCs). This study evaluates ASCs and HSCs for medical complications, readmission rates, implant complications, and costs. This retrospective cohort study used the PearlDiver Mariner Database to identify patients undergoing primary TSA in ASCs or HSCs, assessing medical complications, readmissions, implant issues, and costs. ASC patients were matched in a1:5 ratioto HSC patients by age, sex, region, and Elixhauser Comorbidity Index (ECI). Logistic regression analyzed the impact of ASC versus HSC settings on complications and readmissions, while Welch's t-tests compared costs. Statistical significance was determined by a P value less than or equal to 0.05. ASCs showed lower odds of pulmonary embolism (OR = 0.69; P = 0.04), total medical complications (OR = 0.89; P = 0.01), prosthetic joint dislocation (OR = 0.43; P = 0.05), and total implant-related complications (OR = 0.85; P = 0.03), but a higher 90-day readmission rate (OR = 1.22; P < 0.01). ASCs also offered significant cost savings on the day of surgery ($4600 vs. $11,100; P < 0.01) and for 90-day total costs ($6600 vs. $13,500; P < 0.01) compared to HSCs. Outpatient primary TSA in ASCs offers comparable safety with substantially lower costs than HSCs. Despite higher readmission rates, ASCs represent a viable, cost-effective alternative.

Anesthesia Provider and Facility Practice Patterns in Ambulatory Surgical Centers Caring for Children: A Survey of the Society for Ambulatory Anesthesia.

Anesthesia Provider and Facility Practice Patterns in Ambulatory Surgical Centers Caring for Children: A Survey of the Society for Ambulatory Anesthesia.

Cost comparison of orthopedic sports medicine procedures in an ambulatory surgical centre and a hospital outpatient department.

Ambulatory surgery centres are becoming an attractive alternative to hospital-based outpatient departments; however, limited data exist on their cost efficacy in a publicly funded health care model. In this study, we aimed to compare costs for ambulatory sports medicine procedures performed at an ambulatory surgery centre and a hospital outpatient department. We retrospectively identified patients who underwent rotator cuff repair, anterior cruciate ligament reconstruction (ACLR), or hip arthroscopy between January 2020 and August 2022. We collected demographic characteristics, procedural costs, and procedural data. We used 2-sample t tests to compare care-related costs between groups treated in an ambulatory surgery centre and hospital outpatient department. After controlling for age and concomitant procedures, we included a total of 132 patients for analysis. Patients who underwent hip arthroscopy or rotator cuff repair in an ambulatory surgery centre had significantly shorter duration of total operating room time, and procedural duration was equivocal (p > 0.1) between sites. Procedure time for ACLR was significantly shorter in the group treated in an ambulatory surgery centre than in the group treated in a hospital outpatient department (p = 0.01). The total case costs for the ambulatory surgery centre were significantly lower for hip arthroscopy ($3543, standard deviation (SD) $365 v. $6209, SD $681; p < 0.05), rotator cuff repair ($4259, SD $934 v. $5786, SD $934; p < 0.05), and ACLR ($3136, SD $459 v. $4821, SD $1511; p < 0.05), despite a lack of differences in associated disposable implant costs for ACLR and rotator cuff repair (p > 0.1). Material costs were significantly lower in the group receiving hip arthroscopy at an ambulatory surgery centre than in the group receiving the same procedure at a hospital outpatient department (p < 0.05). There were no differences in immediate 6-week postoperative care-associated costs between groups (p > 0.4). Ambulatory sports medicine procedures performed at an ambulatory surgery centre were associated with significantly reduced operating room time and total cost compared with matched cases performed via a hospital outpatient department. Ambulatory surgery centres provide an opportunity to improve cost efficacy and reduce wait-lists for surgical care.

Clinical Outcomes for Workers' Compensation versus Commercially Insured Patients Following Ambulatory Lumbar Decompression: A Cohort Matched Analysis with Two-Year Follow-Up.

Clinical Outcomes for Workers' Compensation versus Commercially Insured Patients Following Ambulatory Lumbar Decompression: A Cohort Matched Analysis with Two-Year Follow-Up.

Impact of the day of the week on clinical outcomes following anterior cervical discectomy and fusion surgery.

Previous research suggests elective surgical procedures performed later in the week have worse outcomes. This study investigated whether the day of the week on which elective anterior cervical discectomy and fusion (ACDF) surgery was performed impacts clinical outcomes. Using data from the Quality Outcomes Database, a nationwide, multicenter prospective registry, this study included patients undergoing elective ACDF for cervical spondylosis. Patients were categorized into groups based on the surgery day (early week, Monday and Tuesday; late week, Thursday and Friday). Analyzed outcomes included postoperative complications, readmissions, reoperations, and patient-reported outcomes. Statistical methods included the independent t-test, Pearson's chi-square test, and multivariable logistic regression. The study analyzed 19,818 patients, with 41.7% undergoing surgery early in the week and 36.9% later. There were no significant differences in 30-day mortality, readmissions, or reoperations between the two groups. Early-week surgical procedures were associated with a higher incidence of postoperative dysphagia requiring nasogastric tubes (0.6% vs 0.3%, p = 0.02) and a higher incidence of vocal cord paralysis (0.5% vs 0.3%, p = 0.01). The data indicate a surgical selection bias with more complex surgical procedures and higher risk patients typically scheduled earlier in the week, which likely contributed to the increased rates of dysphagia. Conversely, patients who underwent operations on Fridays were more likely to be discharged on the same day compared to those earlier in the week (p = 0.02), without a significant difference in length of stay overall. Surgical procedures performed later in the week were more likely to be performed at ambulatory surgical centers rather than inpatient facilities (p < 0.01), indicating a strategic selection of healthier patients for end-of-week procedures. The day of elective ACDF surgery does not affect mortality, readmissions, or reoperation rates. However, early-week surgical procedures may see slightly higher rates of postoperative dysphagia and vocal cord paralysis, likely due to the scheduling of more complex cases or higher risk patients during these days. Overall, the authors' data confirm that day of surgery does not influence overall patient recovery significantly. This information is useful for surgical planning and for providing patient reassurance that the day of the week does not significantly impact surgical outcomes.

Ask, Acknowledge, Ascend: Addressing Mistrust as a Strategy to Address Disparities in Orthopaedic Ambulatory Care.

Advances in minimally invasive surgical techniques, robotics, anesthesia techniques, and recovery protocols have been instrumental in shifting orthopaedic surgical care from the hospital-based operating room to ambulatory surgical centers. Outpatient surgical services are thought to offer a lower-cost model of care, reduced out-of-pocket expenses, more predictable scheduling, faster recovery times, convenience, and lower risk of nosocomial infections. With these known advantages, it is critical to examine whether this safer environment is accessible to all. Racial/ethnic and gender disparities have been well-documented in the inpatient orthopaedic environment and concern has been raised that the shift toward outpatient surgery could widen disparities and access to care. This article describes ongoing disparities in ambulatory orthopaedic surgery for racialized minorities, women, and people with obesity. Having experienced these disparities, many lack trust in health care providers and the health system. Approaches for addressing this mistrust to create meaningful patient-centered care are described.

Potential improvement in spatial accessibility of methadone treatment with integration into other outpatient substance use disorder treatment programs, New York City, 2024.

Methadone is an effective treatment for opioid use disorder; however, its provision in the US is limited to federally-regulated opioid treatment programs (OTP). Expansion of methadone treatment into non-OTP substance use disorder (SUD) treatment programs ('expanded methadone treatment access') is a promising intervention to increase access. We performed a cross-sectional geospatial analysis of public transit times to OTPs, expanded methadone treatment access, and other healthcare facilities as of March, 2024 in New York City (NYC). We estimated one-way public transit travel time and compared travel times using population weighted paired t-tests. For OTPs, 38.2% (95% CI: 38.0, 38.4) of the NYC population was within 15 minutes and 79.7% (95% CI: 79.5, 79.9) was within 30 minutes. For expanded methadone treatment access, 72.1% (95% CI: 71.9, 72.2) of the NYC population was within 15 minutes and 97.5% (95% CI: 97.5, 97.6) was within 30 minutes. The mean travel time was 20.4 minutes (SD: 10.9) for OTPs and 12.1 minutes (SD: 7.1) for expanded methadone treatment access (difference: -8.3 minutes [95% CI: -8.5, -8.1]; P < 0.001). The mean travel time for expanded methadone treatment access was slightly longer than the mean travel time for dialysis facilities (difference: 0.22 minutes [95% CI: 0.06, 0.39]; P = 0.009]), not significantly different than Federally Qualified Health Centers (difference: -0.06 minutes [95% CI: -0.22, 0.11]; P = 0.51), and significantly shorter than the mean travel time to ambulatory surgical centers (difference: -6.3 [95% CI: -6.5, -6.0]; P < 0.001) and hospitals (difference: -8.1 [95% CI: -8.3, -7.9]; P < 0.001). Efforts to increase access to methadone treatment in the US should promote expansion to additional non-OTP outpatient SUD treatment programs. Such integration is anticipated to increase spatial accessibility of methadone treatment substantially, greatly enhancing the potential for patient access.

Optimizing Durable Medical Equipment at an Ambulatory Surgery Center.

Orthopaedic outpatient surgery in the form of Ambulatory Surgical Centers (ASCs) continues to rise over the past several decades with enhancements for the patient and organization that includes ease of convenience, efficiency, and cost-effectiveness when examining the comparison to a traditional hospital with outpatient departments (Wang, K. Y., Puvanesarajah, V., Marrache, M., Ficke, J. R., Levy, J. F., & Jain, A. (2022). Ambulatory surgery centers versus hospital outpatient departments for orthopaedic surgeries. Journal of the American Academy of Orthopaedic Surgeons, 30(5), 207-214). Furthermore, the rise of ASCs also includes various ownership models such as a sole physician, ASC management company, or a health system, which also commonly results in a blend of all three elements based on the strategy of the group. The purpose of this brief is to examine the unique delivery role that durable medical equipment (DME) plays in the care for patients following an orthopaedic surgery at an ASC when providing DME by Certified Athletic Trainers. Optimizing Certified Athletic Trainers in the ASC space creates opportunities for improving patient satisfaction and surgical staff burden while adding revenue to the ASC.

The Healthcare Subsidy Assessment Survey: A Novel and Validated Poverty Assessment Tool to Inform Medical Cost Subsidization in Rural Uganda.

Approximately 30% of the global burden of disease is surgical, but two-thirds of the world's population cannot access safe, affordable, and timely surgical care. An ambulatory surgical center (ASC) in Uganda offers subsidized and free care to some patients, but identifying patients in greatest need is challenging. We aimed to develop an unbiased tool appropriate for medical settings to determine subsidy eligibility to prevent catastrophic healthcare expenditure (CHE) for ASC's patients. Utilizing a modified simple poverty scorecard (SPS), expert opinions, and literature review, the center developed a new poverty assessment tool (PAT), the healthcare subsidy assessment (HSA). The HSA was implemented alongside the SPS at ASC. Principal component analysis (PCA) was used to refine the HSA and establish a correlation between the original HSA and SPS to predict CHE likelihood. A 21-question HSA was developed, and 175 patients completed both the HSA and SPS. The questionnaires had a correlation of R2=0.294, p<0.001. PCA identified six distinct components, and the HSA was refined to an 11-question survey (rHSA). After rescaling to 100 for comparison to the SPS and the original HSA, rHSA scores were significantly different between both (p<0.001) but had an improved correlation with the SPS (R2=0.457, p<0.001) and a strong correlation with the original HSA (R2=0.621, p<0.001). We successfully developed and validated the rHSA, a novel PAT tailored for a healthcare setting to better identify and support patients at risk.

P-1381. Gender-based Testing Differences for Chlamydia trachomatis and Neisseria gonorrhoeae in Military Service Members

Abstract Background Chlamydia trachomatis and Neisseria gonorrhoeae infections impose a significant burden to the military, due to its young, sexually active population. In previous studies, female service members had 3-5 times the rate of both these infections as compared to men for unclear reasons. The purpose of this study was to investigate if gender-based differences in infection rates for chlamydia and gonorrhea may be due to gender-based differences in testing practices. Demographic Information of 1620 Military Service Members Tested for Chlamydia trachomatis and Neisseria gonorrhoeae at Brooke Army Medical Center and Wilford Hall Ambulatory Surgical Center June-September 2023 Methods A retrospective chart review was conducted on military service members who underwent testing for chlamydia and gonorrhea at Joint Base San Antonio between June and September 2023. The local electronic health record database was queried to determine patient demographics (age, gender, race, ethnicity, rank, military branch), clinical setting and indications for testing. Results A total of 3768 patients were identified. 2148 female basic trainees who underwent mandatory entry screening were excluded, leaving 1620 (43%) patients for analysis. The cohort was predominantly female (67.5%) and enlisted (84.2%) with a median age of 27. Male patients were more likely to be tested for patient driven factors, such as symptoms (41.2%) or patient request (24.5%). Female patients were most frequently tested due to clinical algorithm (53.0%). Tested male patients were more likely to have a positive result than female patients for both chlamydia (8.7% vs 3.9%, p=&amp;lt; 0.001) and gonorrhea (2.8% vs 0.4%, p=&amp;lt; 0.001) (Table). Conclusion Although women were more frequently tested for chlamydia and gonorrhea infections, male service members had significantly higher positivity rates, with more patient-driven indications for testing. This study implies the higher positivity rates in female patients compared to the male patients that has been previously reported is at least partially due to a testing bias. Disclosures All Authors: No reported disclosures