Can a New, Satellite Inpatient Hospital Maintain the Efficiency of an Ambulatory Surgery Center with No Difference in Patient-reported Outcomes? A Prospective Study

Previous research has found that anterior cruciate ligament (ACL) reconstructions performed at ambulatory surgery centers (ASCs) are more time-efficient. However, recent literature investigating this phenomenon within the pediatric population is limited and primarily retrospective. The goal of this study was to prospectively compare the operating room (OR) efficiency of pediatric ACL reconstructions performed across different surgical settings. Adolescent patients (12–18 years) undergoing ACL reconstruction by a single surgeon were prospectively enrolled from 2020 to 2024. Patients were cohorted based on the location of their surgery at one of three sites: 1) a traditional, tertiary care academic hospital, 2) hospital-owned ASCs, or 3) a satellite inpatient hospital that was built and connected to an ASC in January 2022. Patient preoperative, surgical, and postoperative data were collected, and surgical efficiency was compared across surgical sites using a variety of metrics. Patient-reported outcomes (PROMs) were collected using the Pedi-FABS and Pediatric International Knee Documentation Committee questionnaires. A total of 115 patients (56.5% female, mean age: 15.4 ​± ​1.7 years) met inclusion criteria and were enrolled. Thirty-one patients (27.0%) had ACL reconstructions at the main inpatient hospital, 36 (31.3%) at hospital-owned ASCs, and 48 (41.7%) at the new satellite inpatient hospital. When controlling for concomitant procedures, regional anesthesia type, and staff, there was a significant difference in total OR in-room, anesthesia induction, surgery preparation, surgery duration, and dressing application/wake-up times among the three cohorts (P ​