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

J Am Acad Orthop Surg. 2016 Dec;24(12):865-871. doi: 10.5435/JAAOS-D-15-00751.


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.

Level of evidence: Level II.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Ambulatory Surgical Procedures / economics*
  • Ambulatory Surgical Procedures / statistics & numerical data
  • Child
  • Child, Preschool
  • Cost Savings / statistics & numerical data*
  • Female
  • Hospital Costs / statistics & numerical data*
  • Hospitals, Pediatric / economics*
  • Hospitals, University / economics*
  • Humans
  • Infant
  • Linear Models
  • Male
  • Orthopedic Procedures / economics*
  • Surgicenters / economics*
  • Surgicenters / statistics & numerical data
  • United States