Study details impacts on hospital that moved total joints surgeries to ASC

Researchers at Luminis Health Anne Arundel Medical Center in Annapolis, Md., describe positive impacts on the hospital's acute-care operations and quality after transitioning elective orthopedic surgeries to an ambulatory setting.

Anne Arundel Medical Center researchers describe the impacts to the hospital after it moved total joints and some spine procedures to its affiliated ASC.

The retrospective single-center study, published on Cureus on Dec. 30, is particularly relevant as more health systems and hospitals continue to partner with, purchase or build ASCs to host elective surgeries such as total joint arthroplasty (TJA) and some spine procedures in order to free up their inpatient hospital ORs for patients with more acute or complex cases. The open access, peer-reviewed study examines how the transition of TJA and spine procedures to Anne Arundel Medical Center's ASC affected patient acuity and outcomes in the hospital’s specialized joint and spine unit (JSU).

The study evaluated 12,067 patients who received care at the Anne Arundel Medical Center JSU during 2018-2019 and 2022-2023. Those date ranges are notable, as the hospital began performing TJA and spine procedures in an affiliated ASC in 2021.

The research team compared patient characteristics and outcomes between the “pre-ASC” and “post-ASC” periods for three groups: all patients, patients undergoing total joint or spine surgery, and patients not undergoing total joint or spine surgery but admitted for other reasons. Additionally, operational measures, quality indicators and staffing measures were compared between time periods for the entire unit.

Impressive results bolster concept of outpatient migration

Compared to pre-ASC patients, those receiving care in the JSU post-ASC were older and had higher BMIs on average. The post-ASC population also was more diverse at the JSU, with a greater percentage of Black (17.7% vs. 14.0%) and Medicaid patients (1.7% vs. 0.6%). Post-ASC patients presented with a higher comorbidity burden as demonstrated by higher Charlson Comorbidity Index, severity of illness, and risk of mortality scores.

Joint/spine surgery patients accounted for 71.0% of patients in the JSU post-ASC, significantly down from 90.7% pre-ASC. Meanwhile, emergency department (ED) arrivals increased from 5.3% to 24.2% of JSU patients post-ASC.

Average hospital length of stay (LOS) increased from 1.6 days pre-ASC 1.6 to 2.6 days post-ASC, while rates of 0/1 day LOS decreased and rates of 2+ day LOS increased post-ASC. While rates of skilled nursing facility discharge and 30-day readmissions increased post-ASC, 30-day ED return rates remained stable. “These trends were largely driven by the outcomes of non-total joint/spine surgery patients,” the researchers note.

Evidence builds

Overall, the data further backs up the trend of migrating elective surgeries out of hospitals and into ASCs. Healthier patients undergoing elective surgeries no longer require as many hospital ORs, beds and resources, allowing the JSU up to handle a larger number of sicker patients with more acute conditions.

“This study highlights the changing patient landscape of a specialized orthopedic unit that has seen a growth in medically complex cases amidst the opening of a hospital-affiliated ASC,” the researchers write. “While these changes cannot be considered directly caused by the ASC opening, further evaluation of the impact of the migration of orthopedic surgeries to ASCs is warranted to confirm or refute the findings from this retrospective single-center study. These findings highlight the challenges of caring for a more racially and socioeconomically diverse population; hospitals should continue to refine strategies for delivering high-quality, equitable care as the demographics of patients treated in the acute-care setting evolve.”

Read the comprehensive, data-rich full study here.