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Advancements in joint replacement surgery have resulted in shorter hospital lengths of stay as well as the migration of these procedures to outpatient surgery centers. As the demand for these procedures grows and pressure builds for cost containment in healthcare, choice of the operative facility based on patient acuity should be considered. In this study, the use of an ambulatory surgery center (ASC) for patients with no signiﬁcant operative risk factors was evaluated.
Twenty patients meeting American Society of Anesthesia physical status score of one or two and with no substantial comorbidities placing them at risk for intraoperative or postoperative complications were selected to receive their total joint replacement in The Surgery Center at Lutheran (TSCAL) in Wheat Ridge, Colorado. These patients were released between eight and twenty-three hours following surgery. Hospital transfers, follow-up emergency room visits, post-op complications, cost and patient satisfaction were tracked following surgery.
None of the twenty patients in the study were transferred or readmitted to the hospital or emergency room, and no post-op infections or deep vein thrombosis have been reported in the six weeks following surgery. Compared to patients undergoing the same procedure in a hospital, the average savings per procedure savings is forty-six percent or as much as ﬁfteen thousand dollars. Patients reported high satisfaction with the procedure and process.
While our initial outcomes were promising with no complications or transfers, the small sample size makes it diﬃcult to extrapolate the expected complication rate in a larger population.
For select patients in overall good health, the TSCAL has shown to be an appropriate alternative to the hospital for total joint replacement surgery. With a highly trained and dedicated team, our program has been able to achieve high-quality results with signiﬁcantly lower overall costs. Since the completion of the initial twenty patients that were kept from eight to twenty-three hours, patients can now expect to go home within six to eight hours. This has tremendous positive implications for the future of these procedures from both a cost and quality perspective.