Orthopedics and spine are among the hottest specialties for ASCs and outpatient settings this year, driven by CMS’ removal of nearly 300 musculoskeletal procedures from its IPO list.
This shift is leading to better outcomes and recovery for many patients who received care in ASCs, which will only continue to push procedures to these facilities, according to one orthopedic surgeon.
Orthopedic surgeons have all the same surgical capabilities in ASCs compared to hospitals, which is just another reason for the push.
Brian Nwannunu, MD, an orthopedic surgeon at the Texas Joint Institute in Dallas, recently connected with Becker’s to share how the drive to outpatient settings will change orthopedics this year.
Note: Responses were lightly edited for clarity and length.
Question: What is a big trend you’re paying attention to in 2026?
Dr. Brian Nwannunu: A lot of our orthopedic procedures are now being moved to the ambulatory surgery center or the outpatient setting. I think that’s excellent, because patients just do better at home. The hospital is great, but you can get infections, you can fall and you just don’t have your full routine. You get better at home. It’s also a lower cost to the hospital system. As you can imagine, the hospital costs more because you just have to pay for bodies. You can’t just leave your grandma in the hospital overnight with no one there, so you have to pay for somebody to be there, even if they’re not doing anything. In my experience, a lot of patients the next morning, they wake up and feel like they could have just gone home yesterday.
CMS has taken a number of previously inpatient only procedures that now took them off that list, so we can do them outpatient. I think that’s going to not only drive better outcomes, but it’s going to drive a lot of cases to the outpatient center. Personally, I do about 50% of my patients in the outpatient center. That’s going to be a big trend for 2026 and not just in joint replacements, which I do, but in spine and in foot and ankle and complex reconstruction.
Q: What are some of the biggest differences you see in patient outcomes between ASC and hospital settings?
BN: It is all about patient selection. The patient has to be healthy enough to be an outpatient candidate, even for something like a routine total knee arthroplasty, which takes most surgeons under an hour. The surgery side of things is not always the tough part, but if the patient is sick or not healthy enough, then their heart may not be able to tolerate the anesthesia and go home. They may need monitoring. If they had previous COPD and they were on oxygen, they may need to stay on some extra oxygen. If they have kidney issues and they need a little bit of extra fluid, they may need to be hooked up to an IV, all which cannot be done at home.
From a technical standpoint, anything I do in an inpatient setting, I can do in an outpatient setting. I will try to be a little bit more sensitive about the patient’s pain. We’re implementing different pain protocols, nerve blocks, intra articular injections or medication that lasts much longer. We’re trying to give them multiple different types of medications, not just narcotics, but anti-inflammatories, muscle relaxants and things that can last in their system much longer, so that they’re comfortable at home. Pain is another aspect of things that drives people back to the ERs, so controlling the pain is important. Those are the real drivers for myself and others to want to go more outpatient.
