Research Article

Cost Savings From Utilization of an Ambulatory Surgery Center for Orthopaedic Day Surgery

Fabricant, Peter D. MD, MPH; Seeley, Mark A. MD; Rozell, Joshua C. MD; Fieldston, Evan MD, MBA; Flynn, John M. MD; Wells, Lawrence M. MD; Ganley, Theodore J. MD

Author Information

From the Hospital for Special Surgery, New York, NY (Dr. Fabricant), the Geisinger Health System, Danville, PA (Dr. Seeley), the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Dr. Rozell), and the Children’s Hospital of Philadelphia, Philadelphia (Dr. Fieldston, Dr. Flynn, Dr. Wells, and Dr. Ganley).

Dr. Fieldston or an immediate family member has stock or stock options held in Johnson & Johnson and Pfizer. Dr. Flynn or an immediate family member has received royalties from Zimmer Biomet and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American Board of Orthopaedic Surgery, the Pediatric Orthopaedic Society of North America, and the Scoliosis Research Society. Dr. Wells or an immediate family member serves as a board member, owner, officer, or committee member of the Philadelphia Orthopaedic Society. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Fabricant, Dr. Seeley, Dr. Rozell, and Dr. Ganley.

Correspondence to Dr. Fabricant: [email protected]

Journal of the American Academy of Orthopaedic Surgeons 24(12):p 865-871, December 2016. | DOI: 10.5435/JAAOS-D-15-00751

Abstract

Introduction:

Healthcare providers are increasingly searching for ways to provide cost-efficient, high-quality care. Previous studies on evaluating cost used estimated cost-to-charge ratios, which are inherently inaccurate. The purpose of this study was to quantify actual direct cost savings from performing pediatric orthopaedic sports day surgery at an ambulatory surgery center (ASC) compared with a university-based children’s hospital (UH).

Methods:

Custom-scripted accounting software was queried for line-item costs for a period of 3 fiscal years (fiscal year 2012 to fiscal year 2014) for eight day surgery procedures at both a UH and a hospital-owned ASC. Hospital-experienced direct costs were compared while controlling for surgeon, concomitant procedures, age, sex, and body mass index.

Results:

One thousand twenty-one procedures were analyzed. Using multiple linear regression analysis, direct cost savings at the ASC ranged from 17% to 43% for seven of eight procedures. Eighty percent of the cost savings was attributed to time (mean, 64 minutes/case; P < 0.001) and 20% was attributed to supply utilization (P < 0.001). Of the time savings in the operating room, 73% (mean, 47 minutes; P < 0.001) was attributed to the surgical factors whereas 27% (17 minutes; P < 0.001) was attributed to anesthesia factors.

Conclusions:

Performing day surgery at an ASC, compared with a UH, saves 17% to 43% from the hospital’s perspective, which was largely driven by surgical and anesthesia-related time expenditures in the operating room.