High-Volume and Privately Owned Ambulatory Surgical Centers Reduce Costs in Achilles Tendon Repair

Background: While Achilles tendon repairs are common, little data exist characterizing the cost drivers of this surgery. Purpose: To examine cases of primary Achilles tendon repair, primary repair with graft, and secondary repair to find patient characteristics and surgical variables that significantly drive costs. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: A total of 5955 repairs from 6 states were pulled from the 2014 State Ambulatory Surgery and Services Database under the Current Procedural Terminology codes 27650, 27652, and 27654. Cases were analyzed under univariate analysis to select the key variables driving cost. Variables deemed close to significance ( P < .10) were then examined under generalized linear models (GLMs) and evaluated for statistical significance ( P < .05). Results: The average cost was $14,951 for primary repair, $23,861 for primary repair with graft, and $20,115 for secondary repair ( P < .001). In the GLMs, high-volume ambulatory surgical centers (ASCs) showed a cost savings of $16,987 and $2854 in both the primary with graft and secondary repair groups, respectively (both P < .001). However, for primary repairs, high-volume ASCs had $2264 more in costs than low-volume ASCs ( P < .001). In addition, privately owned ASCs showed cost savings compared with hospital-owned ASCs for both primary Achilles repair ($2450; P < .001) and primary repair with graft ($11,072; P = .019). Time in the operating room was also a significant cost, with each minute adding $36 of cost in primary repair and $31 in secondary repair (both P < .001). Conclusion: Private ASCs are associated with lower costs for patients undergoing primary Achilles repair, both with and without a graft. Patients undergoing the more complex secondary and primary with graft Achilles repairs had lower costs in facilities with greater caseload.

Ambulatory Surgical Centers: Improving Quality of Operative Spine Care?

Study Design: Narrative review with commentary. Objective: Present healthcare reform focuses on cost-optimization and quality improvement. Spine surgery has garnered particular attention; owing to its costly nature. Ambulatory Surgical Centers (ASC) present a potential avenue for expenditure reduction. While the economic advantage of ASCs is being defined, cost saving should not come at the expense of quality or safety. Methods: This narrative review focuses on current definitions, regulations, and recent medical literature pertinent to spinal surgery in the ASC setting. Results: The past decade witnessed a substantial rise in the proportion of certain spinal surgeries performed at ASCs. This setting is attractive from the payer perspective as remuneration rates are generally less than for equivalent hospital-based procedures. Opportunity for physician ownership and increased surgeon productivity afforded by more specialized centers make ASCs attractive from the provider perspective as well. These factors serve as extrinsic motivators which may optimize and improve quality of surgical care. Much data supports the safety of spine surgery in the ASC setting. However, health care providers and policy makers must recognize that current regulations regarding safety and quality are less than comprehensive and the data is predominately from selected case-series or comparative cohorts with inherent biases, along with ambiguities in the definition of “outpatient.” Conclusions: ASCs hold promise for providing safe and efficient surgical management of spinal conditions; however, as more procedures shift from the hospital to the ASC rigorous quality and safety data collection is needed to define patient appropriateness and track variability in quality-related outcomes.