BackgroundPrevious research has found that anterior cruciate ligament (ACL) reconstructions performed at Ambulatory Surgery Centers (ASCs) are more time efficient. However, recent literature investigating this phenomenon within the pediatric population is limited and primarily retrospective. The goal of this study was to prospectively compare the operating room (OR) efficiency of pediatric ACL reconstructions performed across different surgical settings. MethodsAdolescent patients (12-18 years) undergoing ACL reconstruction by a single surgeon were prospectively enrolled from 2020-2024. Patients were cohorted based on the location of their surgery at one of three sites: 1) a traditional, tertiary-care academic hospital, 2) hospital-owned ASCs, or 3) a satellite inpatient hospital that was built and connected to an ASC in January 2022. Patient preoperative, surgical, and postoperative data was collected, and surgical efficiency was compared across surgical sites using a variety of metrics. Patient-reported outcomes (PROMs) were collected using the Pedi-FABS and Pedi-IKDC questionnaires. ResultsA total of 115 patients (56.5% female, mean age 15.4 +/- 1.7 years) met inclusion criteria and were enrolled. 31 patients (27.0%) had ACL reconstructions at the main inpatient hospital, 36 (31.3%) at hospital-owned ASCs, and 48 (41.7%) at the new satellite inpatient hospital. When controlling for concomitant procedures, regional anesthesia type, and staff, there was a significant difference in total OR in-room, anesthesia induction, surgery preparation, surgery duration, and dressing application/wake-up times among the three cohorts (p<0.001). Both the ASCs and the satellite inpatient hospital had shorter total OR in-room and surgery duration times than the main inpatient hospital (p<0.001). There were no differences in patient-reported outcomes among the three cohorts (p>0.05). ConclusionsAdolescent ACL reconstructions performed at either an ASC or a satellite inpatient hospital were more time efficient than those performed at a traditional, main inpatient hospital with no differences in PROMs. Institutions should consider implementing strategies used at ASCs, such as standardized surgical teams, at main hospitals to increase efficiency. Level of EvidenceII (Prospective Cohort Study)