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PURPOSE: Plastic surgeons frequently use and own ambulatory surgery centers (ASCs). Research suggests that freestanding ASCs (F-ASCs) and hospital-owned ASCs (HO-ASCs) provide more efficient, less costly care relative to hospital outpatient departments (HOPDs). Limited research has analyzed access, cost, and unplanned postoperative visits between ASC types for common same-day plastic surgeries, including laceration repair, local tissue rearrangement, skin grafting, panniculectomy, reduction mammaplasty, breast reconstruction, and revision breast reconstruction. METHODS: The Healthcare Cost and Utilization Project all-payer databases were queried. Patients were propensity-score matched by age and individual comorbidity data. Multivariable regression was used to assess disparities in access, cost, and unexpected hospital visits by facility type. RESULTS: In total, 128, 805 matched patients were included. Relative to privately insured patients, public insurance beneficiaries experienced lesser odds of HO-ASC (Medicare OR: 0. 85, 95%CI: 0. 80 to 0. 90, p<0. 001; Medicaid OR: 0. 66, 95%CI: 0. 63 to 0. 70, p<0. 001) or F-ASC use (Medicare OR: 0. 81, 95%CI: 0. 76 to 0. 86, p<0. 001; Medicaid OR: 0. 24, 95%CI 0. 22 to 0. 26, p<0. 001). Relative to HOPDs, HO-ASC charges were 7, 523 less (95%CI: -7, 899 to -7, 147, p<0. 001), while F-ASC charges were 19, 058 less (95%CI: -19, 446 to -18, 669, p<0. 001). Odds of 7-day postoperative emergency room or hospital visits for those treated at F-ASC were 0. 3 times lower than the patients treated at HOPDs. CONCLUSION: F-ASC based surgery is less costly and associated with fewer postoperative visits than alternative same-day surgery sites. Additionally, disparities in F-ASC access are likely driven by primary payer. Policy promoting independent ASC ownership and F-ASC use through reimbursement parity will yield substantial savings for the US healthcare system.
Fahmy et al. (Wed,) studied this question.