ASC improves hospital efficiency, maintains outcomes despite higher-acuity joint replacement patients

Editor's Note

Opening a hospital-affiliated ambulatory surgery center (ASC) can shift healthier patients out of the hospital without compromising outcomes for those who remain, according to a new study published in the Journal of the AAOS Global Research & Reviews in April 2025. The retrospective analysis from Luminis Health Anne Arundel Medical Center found that after an ASC was introduced, total joint arthroplasty (TJA) patients treated in the hospital were older, sicker, and more complex—but they still had shorter hospital stays, fewer discharges to skilled nursing facilities (SNFs), and lower costs.

As detailed in the study, researchers compared 7,775 TJA patients across two periods: before the ASC opened (2018–2019) and after it was fully operational (2022–2023). They found that post-ASC, hospital patients were more likely to be age 75 or older (29% vs 17.8%), have an ASA score of ≥3 (50.6% vs 41.7%), and undergo revision procedures (8.3% vs 6.7%). Despite these shifts, same-day discharge rates more than doubled (16.5% vs 6.3%), SNF discharges dropped (6.9% vs 9.3%), and average charges decreased by over $450 per case.

According to the article, these outcomes were achieved within a long-standing TJA pathway that included enhanced recovery protocols, multidisciplinary coordination, and patient engagement tools. The hospital replicated this pathway at the ASC, ensuring consistency in perioperative care and discharge planning.

The researchers emphasize that while patient acuity rose in the hospital setting following the outpatient migration, quality remained stable. No statistically significant differences were seen in 30-day emergency department returns or readmissions. Patient-reported outcomes also remained consistent, even as survey response rates and follow-up timelines improved post-ASC.

The study suggests the observed efficiency gains and stable outcomes were likely supported by a mature clinical infrastructure and coordinated perioperative management. However, the authors caution that as ASCs take on a greater share of low-risk TJA cases, hospital-based programs will need to prepare for increasingly complex caseloads—possibly requiring more use of intensive resources in the future.