Increasing Utilization, Rising Facility Charges, and Evolving Procedure Mix in Hip Arthroscopy at United States Hospital-Based Ambulatory Surgical Centers From 2016 to 2022.

PURPOSE: To evaluate national trends in hip arthroscopy utilization and procedure mix, assess adjusted total costs by subtype, and examine regional and payer variation in case distribution among hospital-based ambulatory surgical centers (ASCs) from 2016 to 2022.

METHODS: Using the Healthcare Cost and Utilization Project National Ambulatory Surgery Sample, we identified hip arthroscopy encounters in hospital-based ASCs (2016-2022) using Current Procedural Terminology codes across all procedure fields. Femoroacetabular impingement syndrome (FAIS)-related procedures were defined by femoroplasty (29914), acetabuloplasty (29915), and/or labral repair (29916), alone or with diagnostic arthroscopy, synovectomy, labral debridement, or chondroplasty. Outcomes were assessed at the index encounter. Inflation-adjusted charges, procedure volume, and FAIS market share were analyzed using survey-weighted regression with pairwise contrasts (P < .05).

RESULTS: A total of 107,227 unweighted procedures corresponded to 141,870 nationally weighted encounters. Femoroplasty (67.7%) and labral repair (54.2%) were most common and increased annually (828 and 704 cases/year; both P < .001), whereas labral debridement declined (249 cases/year; P = .012). Median inflation-adjusted charges increased from $32,745 (2016) to $45,782 (2022) (P < .001), with highest charges for femoroplasty alone ($58,697) and multicode FAIS procedures. Private insurance accounted for ~70% of cases, whereas Medicaid increased from 8.9% to 11.7% (P < .001). FAIS-related utilization (volume of arthroscopy encounters including FAIS procedures) increased across all payer groups (1.3%-2.0%/year; all P ≤ .007). Regional growth was steepest in the South (1.9%/year) and Northeast (1.4%/year) versus the West (0.8%/year); the South grew 1.1%/year faster than the West (P = .007).

CONCLUSIONS: Hip arthroscopy in hospital-based ASCs has become more common and costly, with increasing utilization of FAIS-related procedures and regional differences in adoption.

CLINICAL RELEVANCE: These findings provide contemporary national benchmarks of outpatient hip arthroscopy utilization, procedure mix, and facility charges in hospital-based ASCs, informing efforts to optimize value and equitable access to care in the United States.