Improvements in Ureteroscopy Efficiency When Performed at an Ambulatory Surgery Center

We compared the perioperative efficiency and outcomes of ureteroscopy performed at an ambulatory surgery center versus a tertiary care academic medical center.

With institutional review board approval de-identified records were obtained for ureteroscopies performed by a single surgeon from April 2016 to June 2017 at an ambulatory surgery center and tertiary care academic medical center for patients who were American Society of Anesthesiologists® class 1 or 2. Controlling for patient, stone and case order characteristics, multiple linear regressions were used to evaluate differences in total, preoperative, operative, postoperative, delay and operating room turnaround times between the 2 facility types. Emergency department visits within 30 days were also assessed.

All mean times were shorter at the ambulatory surgery center compared to the tertiary care academic medical center, including operative time (25 vs 36 minutes, p <0.001), postoperative time (42 vs 103 minutes, p <0.001) and operating room turnaround time (17 vs 58 minutes, p <0.001). On average, patients spent 147 fewer minutes in facility (p <0.001). On multiple linear regression adjusting for covariates significant on univariate analysis, all times were significantly shorter at the ambulatory surgery center than at the tertiary care academic medical center. There was no difference in 30-day emergency department visits (p=0.818).

For the same procedure by the same surgeon, patients spent on average 2.5 hours less in facility if the procedure was performed at an ambulatory surgery center compared to an academic medical center. This difference was driven primarily by perioperative care.