Evolving Trends in Outpatient Hand Surgery Utilization Across Ambulatory Surgical Centers and Hospital-Based Outpatient Departments.

Purpose: Disparities within the field of hand surgery have been extensively described; however, little is known regarding how these disparities have evolved alongside the growth of freestanding ambulatory surgical centers (ASCs). This study sought to examine utilization trends for four common hand procedures and provide a nuanced breakdown of where disparities in the hand surgery delivery model may be arising. Methods: A retrospective review was conducted using the Healthcare Cost and Utilization Project New York State Ambulatory Database from 2015 to 2022. Differences in utilization rates for four hand procedures were assessed and evaluated over time by race/ethnicity for both hospital-based outpatient departments (HOPDs) and ASCs. Poisson and logistic regressions were used to evaluate the utilization rates for these procedures and their associations with various demographic variables. Results: Black, Hispanic, and Asian/Pacific Islander patients were less likely to undergo all four common hand procedures at both ASCs and HOPDs compared to White patients. Similarly, patients with Medicaid insurance and those from lower socioeconomic backgrounds were less likely to be treated at ASCs. However, disparities in utilization rates decreased over time among both Black and Hispanic patients for several procedures in HOPDs when compared to White patients. Conclusions: Despite identifying differences in ASC and HOPD utilization among Black, Hispanic, and Asian patients, there were several trends that suggested these disparities are improving, particularly in HOPDs. These improvements, however, should be considered alongside persistent variability in access to ASCs for minorities, patients with Medicare and Medicaid insurance, and those of lower socioeconomic status. Clinical relevance: As the use of ASCs for hand surgery continues to grow, surgeons should explore strategies and health care policies that expand access to these high-volume surgical centers for minority patients and individuals from lower socioeconomic backgrounds. This may help improve disproportionately higher patient costs incurred between facility types and overall access to surgical care for these patients.