Can a New, Satellite Inpatient Hospital Maintain the Efficiency of an Ambulatory Surgery Center with No Difference in Patient-reported Outcomes? A Prospective Study.

Abstract

Background: Previous research has found that anterior cruciate ligament (ACL) reconstructions performed at ambulatory surgery centers (ASCs) are more time-efficient. However, recent literature investigating this phenomenon within the pediatric population is limited and primarily retrospective. The goal of this study was to prospectively compare the operating room (OR) efficiency of pediatric ACL reconstructions performed across different surgical settings.

Methods: Adolescent patients (12-18 years) undergoing ACL reconstruction by a single surgeon were prospectively enrolled from 2020 to 2024. Patients were cohorted based on the location of their surgery at one of three sites: 1) a traditional, tertiary care academic hospital, 2) hospital-owned ASCs, or 3) a satellite inpatient hospital that was built and connected to an ASC in January 2022. Patient preoperative, surgical, and postoperative data were collected, and surgical efficiency was compared across surgical sites using a variety of metrics. Patient-reported outcomes (PROMs) were collected using the Pedi-FABS and Pediatric International Knee Documentation Committee questionnaires.

Results: A total of 115 patients (56.5% female, mean age: 15.4 ​± ​1.7 years) met inclusion criteria and were enrolled. Thirty-one patients (27.0%) had ACL reconstructions at the main inpatient hospital, 36 (31.3%) at hospital-owned ASCs, and 48 (41.7%) at the new satellite inpatient hospital. When controlling for concomitant procedures, regional anesthesia type, and staff, there was a significant difference in total OR in-room, anesthesia induction, surgery preparation, surgery duration, and dressing application/wake-up times among the three cohorts (P ​< ​.001). Both the ASCs and the satellite inpatient hospital had shorter total OR in-room and surgery duration times than the main inpatient hospital (P ​< ​.001). There were no differences in PROMs among the three cohorts (P ​> ​.05).

Conclusions: Adolescent ACL reconstructions performed at either an ASC or a satellite inpatient hospital were more time-efficient than those performed at a traditional, main inpatient hospital, with no differences in PROMs. Institutions should consider implementing strategies used at ASCs, such as standardized surgical teams, at main hospitals to increase efficiency.

Key concepts: (1)A satellite inpatient hospital and ambulatory surgery centers are more time-efficient for adolescent ACL reconstruction than a main, inpatient hospital.(2)There were no differences in patient-reported functional outcomes after adolescent ACL reconstruction among ASCs, a main inpatient hospital, and a satellite inpatient hospital.(3)A satellite inpatient hospital can be as efficient as an ASC, with no significant difference in quality.

Level of evidence: II (Prospective Cohort Study).