Ambulatory surgery centres (ASC) are becoming an attractive alternative to hospital-outpatient departments (HOPD) as financial constraints and long surgical wait times remain a challenge in the Canadian publicly funded healthcare model. Ambulatory care reduces the need for inpatient admission, reduces care-related costs, and increases surgical volumes for low-acuity procedures. This is particularly applicable to elective surgeries in fields like orthopedic surgery, including sports medicine, which often deals with musculoskeletal conditions in younger patients with fewer medical comorbidities. Ambulatory care centres have been increasingly utilized in other healthcare models which have demonstrated both safety and associated cost-efficacy. However, there is limited data on their cost efficacy in a publicly funded healthcare model. This study aimed to compare costs for ambulatory sport medicine procedures performed at an ASC versus HOPD. Patients who underwent hip arthroscopy (HA), rotator cuff repair (RCR), and anterior cruciate ligament reconstruction (ACLR) between January 2020 and August 2022 at either an ASC or HOPD were retrospectively identified. Demographic characteristics, procedural costs, and procedural data were collected. Care-related costs were compared between ASC and HOPD groups using two sample t-tests. After controlling for age and concomitant procedures, a total of 132 patients were included for analysis. ASC cases had significantly shorter duration of total OR time for HA (137. 32±16. 17 min vs. 150. 64±17. 34 min, p=0. 008), RCR (125. 95±21. 13 min vs. 142. 15±19. 69 min, p=0. 02), and ACLR (89. 14±14. 83 min vs. 114. 86±33. 11 min, p=0. 004), while procedural duration was equivocal (p>0. 11) for HA and RCR between sites. ACLR procedural time was significantly shorter in the ASC group vs. HOPD group (p=0. 013). ASC total case costs were significantly lower for HA (3543±365 vs. 6209±681, p 0. 11). Material costs were significantly lower in the ASC HA group vs. HOPD HA (p 0. 38). Ambulatory sports medicine procedures performed at an ASC were associated with significantly reduced OR time and total cost compared to matched cases performed via a HOPD, without any differences in acute complications. ACSs provide an opportunity to improve cost-efficacy and reduce waitlists for surgical care in a publicly funded healthcare model.
Harrison et al. (Wed,) studied this question.