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Outpatient surgical centers yielded greater efficacy than ORs for ACL reconstruction
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Results showed greater procedural efficacy among pediatric ACL reconstruction procedures performed in an outpatient surgical center compared with a hospital OR.
“Orthopedic-specific OR teams, as commonly utilized in outpatient surgical centers, result in improved efficiency, reduced cost and increased value,” William L. Hennrikus, MD, told Healio.com/Orthopedics.
Hennrikus and colleagues compared procedural efficacy between pediatric patients who either underwent ACL reconstruction in an outpatient surgical center (n=28) or in the hospital OR (n=21). Researchers defined procedural efficacy as shorter total OR time, less total staff and fewer support staff changes, and broke total OR time into in-room to incision time, total procedure time and stop time to out-of-room time.
Results showed surgeries performed in an outpatient surgical center had higher efficacy, with an improvement in total OR time by 30 minutes on average, as well as less total staff. Researchers noted a shorter total procedure time, in-room time to incision time and stop time to out-of-room time among procedures performed in the outpatient surgical center. Surgical technician changes occurred six-times more often and nursing changes occurred 2.5-times more often in the hospital OR. Researchers found procedures in the hospital OR had assistance from more than 30 different nurses and 15 different surgical technicians vs. 10 nurses and 5 surgical technicians in the outpatient surgical center. – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Shital N. Parikh, MD
The results of this study reaffirm other studies, including systematic reviews and meta-analysis, which have found ambulatory surgical centers (ASC) to be an efficient and less expensive alternative to hospital OR for routine outpatient surgical procedures, without compromising patient safety or quality of care. The reasons for this increased efficiency include the ease of scheduling surgery, easier access to OR, decrease in OR turnaround time and overall autonomy to adapt to changing situations or unanticipated needs, both for the surgeons and for the staff.
However, the prime reason for this increased efficiency in an ASC appears to be the availability of consistent, skilled and experienced specialty-specific teams. This is especially true for orthopedic surgery, where higher volume, vastly different and numerous procedures, and varied implant/instrument needs benefit from an orthopedic-specific team. Several reports and books have been published on the importance of such high-performing teams, both within and outside of medical practice. The concept of high-functioning teams has been at the core of many successful industries and organizations, including aviation, manufacturing and sports. Depending on the setting, these teams are called high-performance teams, self-directed teams, lean enterprise teams or Six-Sigma teams.
Of course, ASCs cannot replace hospital ORs for more complex surgical procedures that require inpatient stay, multidisciplinary approach or ICU setting. The 2014 death of famous comedian Joan Rivers during routine outpatient endoscopic surgery should serve as a reminder to focus on proper patient selection, to anticipate potential risks of surgery and anesthesia, and to determine if ASC is the right setting for the patient to have the surgery.
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