Lower Total Shoulder Arthroplasty Cost of Care at an Ambulatory Surgical Center Versus a Main Hospital

Alexander S Guareschi; Caroline P Hoch; James M Deacon; Josef K Eichinger; Richard J Friedman; Christopher E Gross; Daniel J Scott

doi:10.5435/JAAOS-D-23-00901

Lower Total Shoulder Arthroplasty Cost of Care at an Ambulatory Surgical Center Versus a Main Hospital

J Am Acad Orthop Surg. 2024 Dec 3. doi: 10.5435/JAAOS-D-23-00901. Online ahead of print.

Authors

Alexander S Guareschi¹, Caroline P Hoch, James M Deacon, Josef K Eichinger, Richard J Friedman, Christopher E Gross, Daniel J Scott

Affiliation

¹ From the Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC (Guareschi, Deacon, Eichinger, Friedman, Gross, and Scott), and the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill, NC (Hoch).

PMID: 39637402
DOI: 10.5435/JAAOS-D-23-00901

Abstract

Introduction: Total shoulder arthroplasty (TSA) is an increasingly common orthopaedic procedure. Expansion of TSA to outpatient surgical settings has the potential to reduce costs, although there is limited research on the cost and efficiency of this shift in surgical site of care. The purpose of this study is to compare costs and efficiency of TSA between an ambulatory surgical center (ASC) and a hospital.

Methods: Retrospective cost and time data were obtained from 175 surgeries performed from 2019 to 2020 using a single institution's existing cost accounting system (hospital = 97, ASC = 78). In addition, 34 patients were prospectively enrolled undergoing primary anatomic (n = 10) or reverse (n = 24) TSA. Hand-timed data were collected at each location (ASC = 23, hospital = 11) throughout the entire episode of perioperative care. Data were analyzed to investigate the effects of surgery location on labor cost, efficiency, and provider time.

Results: The cost per TSA in the ASC was markedly lower than that in the hospital (ASC = $27,250.59, hospital = $30,266.80; P < 0.001). Examining individual discrete activities, TSA performed at the ASC was markedly longer in multiple preoperative, intraoperative, and postanesthesia care unit categories, with the greatest difference being case duration (ASC = 2.2 hours, hospital = 1.7 hours; P = 0.002). The decreased cost in the ASC, despite longer case duration, can be explained by differences in cost margins between locations with ASC cases having markedly lower costs for almost all categories.

Conclusion: It is markedly more expensive for patients to undergo TSA in a hospital setting than in an ASC. Furthermore, preoperative and postanesthesia care unit times markedly contribute to differences in efficiency associated with different surgical platforms, representing target areas to focus on improving efficiency of care delivery. These findings should be considered by orthopaedic surgeons when considering TSA in patients who are suitable to undergo TSA at an outpatient ASC.

Level of evidence: Level II, Prospective cohort study.