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

Background: Same-day surgery is common in plastic surgery. Sites-of-service are associated with cost differences. Freestanding (F-ASCs) and hospital-owned ambulatory surgery centers (HO-ASCs) are less costly than hospital outpatient departments (HOPDs), though access disparities are reported. Trends in cost, access, and outcomes between same-day surgery facilities for common plastic surgeries have not been evaluated.

Methods: Healthcare Cost and Utilization Project State Ambulatory Surgery and Inpatient databases (2016-2019) were queried for patients who underwent laceration repair, local tissue rearrangement, skin grafting, panniculectomy, reduction mammaplasty, breast reconstruction, and revision breast reconstruction. Patients were 1:1:1 propensity-matched by facility type and outcomes were analyzed with a mixed-effects log-linear regression with repeated measures.

Results: 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) was found. Relative to White patients, F-ASC use increased among Black (OR: 1.05, 95% CI: 1.03 to 1.06, p<0.001) and Hispanic (OR: 1.05, 95% CI: 1.03 to 1.06, p<0.001) patients. F-ASCs had the lowest rates of unexpected postoperative visits (F-ASC OR: 0.28, 95% CI: 0.25-0.32, p<0.001; HO-ASC OR: 0.52, 95% CI: 0.46-0.58, p<0.001).

Conclusion: Incentives encouraging ASC use are maligned with same-day surgery payment policy in the US. Policy that narrows differences in ASC reimbursement relative to HOPDs will improve access to same-day plastic surgery and constrain costs. Narrowing F-ASC access disparities and lower rates of unexpected postoperative visits suggest F-ASCs improve access to same-day plastic surgery.