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TSA Ambulatory Surgery Centers Versus Hospital Surgery Centers: Complications and Costs
Andrew R Horn, M.D., Paul Mastrokostas, BS, Joshua Harounian, BS, Ameer Tabbaa, MD, Ariel N Rodriguez, MD, Asad M Ashraf, M.D., Afshin Razi, MD and Jack Choueka, MD, Maimonides Medical Center, Brooklyn, NY

INTRODUCTION: There has been an increase in the number of primary total shoulder arthroplasty (TSA) procedures being performed in outpatient ambulatory surgical centers (ASC) compared to hospital surgery centers (HSC) due to cost reduction. Well-powered studies comparing TSA between ASCs versus HSCs are limited, therefore the purpose of this study was to compare 1) complication rates; 2) readmission rates; 3) implant-related complications; and 4) costs of care.
METHODS: Using a nationwide database from January 1, 2010 to December 31, 2019, a total of 56,157 patients underwent TSA at an ASC (n=9,367) or HSC (n=46,790). ASC patients were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. Primary endpoints compared 90-day medical complications, 90-day readmission rates, and 2-year implant-related complications. Day of surgery and 90-day episode of care costs were compared. Logistic regression was used to calculate odds-ratios (OR) of the effect of service location on 90-day readmissions and complications. Welch’s t-tests compared costs between the two settings. A p-value less than 0.05 was significant.
RESULTS: Primary TSAs performed at ASCs had lower 90-day medical complications (9.28 vs. 10.83%; OR: 0.89, p=0.01) compared to HSCs. Two-year implant-related complications for ASC performed TSA were significantly lower (3.32% vs. 3.83%; OR: 0.85, p=0.03). ASC patients incurred significantly lower day of surgery ($4,584.56 vs. $11,135.47, p<0.0001) and total 90-day costs ($6,581.24 vs. $13,481.77, p<0.0001). Primary TSAs performed at ASCs had significantly higher incidence (3.12 vs. 2.71%; OR: 1.22, p=0.002) of being readmitted within 90-days compared to HSCs.
DISCUSSION: This study demonstrates that primary TSAs performed at ASCs have lower complications and costs compared to those performed at a HSC, whereas readmission rates increased. Future prospective randomized controlled studies are warranted to further delineate the safety of performing these procedures in various settings.

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