Ambulatory Surgery Center Fracture Care

Objectives: Due to improved regional anesthetic techniques, consistent patient outcomes, and economic incentives, fracture surgery is shifting from hospitals to ambulatory surgery centers (ASC). Orthopedic trauma surgeons now must compete for ASC block time against other orthopedic subspecialty cases such as Arthroplasty, Arthroscopy, and Spine. The purpose of this study was to identify which fracture cases are most suitable for the ASC setting, determine the key factors driving success in outpatient fracture surgery, and assess the value-based opportunity for the healthcare system. Design: Retrospective comparative economic cohort study evaluating outpatient fracture surgery in an orthopaedic ambulatory surgery center compared with (1) hospital-based trauma surgery and (2) elective subspecialty cases performed in the same ASC. Setting: Orthopaedic ambulatory surgery center compared with hospital-based outpatient surgical facilities. Patients/Participants: 2,592 orthopedic trauma patients undergoing fracture surgery in the ASC and hospital setting, and 4,251 non-trauma orthopedic patients treated in an ASC from January 1 to December 31, 2023. Outcome Measures: Fracture surgery CPT codes, location, volume, payments per case, cost margin per case, and cost savings. Results: 319 fracture cases were performed in the ASC, and 569 outpatient fracture surgeries were conducted in a hospital-based setting. ASC-based fracture care showed an average savings of $2,602 compared to hospital-based care for the 12 most common fracture surgeries. Overall, ASC fracture care generated $315,810, while saving the healthcare system approximately $830,000. If the additional 569 fracture cases were performed in the ASC, the center would benefit by an additional $563,310, and the healthcare system would save an additional $1,480,538. Conclusions: ASC surgery has been shown to have lower costs while producing equivalent clinical outcomes to hospital settings. Orthopedic trauma fracture patients and surgeons should have access to care in these centers, but economic factors must be considered. Certain cases are financially beneficial for ASC treatment, but ASCs must prioritize clearance protocols, value-based implants, and efficient trauma fellowship-trained surgeons for successful implementation. The shift to ASC fracture care demonstrates clear benefits and offers significant savings to the healthcare system. Level of Evidence: Level III – Retrospective comparative economic cohort study Key Words: Ambulatory surgery center, value-based care, cost savings, orthopaedic trauma, outpatient fracture surgery.