Access and Cost Trends for Same-Day Plastic Surgery among Propensity-Matched Patients by Site of Service.

Abstract

Same-day surgery is common in plastic surgery. Sites of service are associated with cost differences. Freestanding ambulatory surgery centers (F-ASCs) and hospital-owned ambulatory surgery centers (HO-ASCs) are less costly than hospital outpatient departments (HOPDs), but access disparities have been reported. Trends in cost, access, and outcomes among same-day surgery facilities for common plastic surgical procedures have not been evaluated. Healthcare Cost and Utilization Project state ambulatory surgery and inpatient databases (2016 through 2019) were queried for patients who underwent laceration repair, local tissue rearrangement, skin grafting, panniculectomy, reduction mammaplasty, breast reconstruction, or revision breast reconstruction. Patients were propensity matched 1:1:1 by facility type, and outcomes were analyzed with a mixed-effects log-linear regression with repeated measures. This study included 120,240 patients. Compared with HOPDs, no change in HO-ASC charges and an 8% quarterly decrease in F-ASC charges (95% CI, 0.89 to 0.96; P < 0.001) were found. Relative to White patients, F-ASC use increased among Black patients (OR, 1.05 [95% CI, 1.03 to 1.06]; P < 0.001) and Hispanic patients (OR, 1.05 [95% CI, 1.03 to 1.06]; P < 0.001). F-ASCs had the lowest rates of unexpected postoperative visits (F-ASC: OR, 0.28 [95% CI, 0.25 to 0.32]; P < 0.001; HO-ASC: OR, 0.52 [95% CI, 0.46 to 0.58]; P < 0.001). Incentives encouraging ASC use are aligned with same-day surgery payment policy in the United States. Policy that narrows differences in ambulatory surgery center reimbursement relative to HOPDs will improve access to same-day plastic surgery and constrain costs. Narrowed F-ASC access disparities and lower rates of unexpected postoperative visits suggest that F-ASCs improve access to same-day plastic surgery.