Navigating the Limitations and Obstacles of TJA in a Free-Standing ASC

Abstract

Outpatient surgery can be performed in three different environments: (1) standard hospital operating room (OR), (2) hospital outpatient department (HOPD), and (3) free-standing ambulatory surgery centers (hereafter referred to as “ASC”). Although initially met with skepticism, a growing body of evidence suggests that TJA can be safely performed in an outpatient environment. The impetus for this shift is multifactorial. ASCs represent a lower cost alternative to hospitals for outpatient procedures. ASCs are designed to accommodate high volume efficiently and provide surgeons an environment to perform more cases in less time than a traditional hospital environment, with more personal control. There may be opportunities for surgeons to participate as equity partners in certain facilities, which provides additional revenue. Finally, patients enjoy the efficiency at ASCs and report high patient satisfaction. That being said, safely performing TJA in an ASC is not without its challenges. Understanding the fundamental differences inherent in performing an outpatient joint arthroplasty at an ASC as opposed to a hospital or HOPD is critical for success, patient safety, and quality. The purpose of this chapter is to highlight the limitations and obstacles of performing TJA at an ASC. We will address not just the challenges, but also propose solutions and provide insights that can assist in ensuring surgeons can transition to an ASC environment efficiently.