By James X. Stobinski, Ph.D., RN, CNOR(E), CSSM(E), CNAMB(E)
I recently reviewed a number of articles on the evolution of Ambulatory Surgery including the recent thought-provoking article, “The ASC Surge”, in the Winter 2026 issue of OR Today.1 These articles prompted some reflection on the evolution of ambulatory surgery. When I began working in perioperative nursing in the mid-1980s our total joint cases, whether knees or hips, had a lengthy inpatient hospital stay. In comparison, total knee arthroplasties are now routinely scheduled as outpatient procedures for healthy patients and outpatient hip replacements are possible for some patients.
The prevalence of chronic disease such as osteoarthritis with an aging population that is living longer fuels the demand for surgery and stokes ASC volume. Industry reports inform us that 65% of surgeries performed in the U.S. are performed in an ASC.2 The projected market value of ASCs is estimated at $46.83 billion in 2025.3 New service lines in ASCs include spine, cardiology and total joints.4 The projected compound annual growth rate (CAGR) for ASCs is projected at 4.1% to the year 2032 with a market value of $62.03 billion.3
The long-term trend of higher surgical volumes in ASCs is clear. We see a movement from inpatient to outpatient procedures but also a shift from outpatient surgeries performed in hospitals to these cases being done in ambulatory surgery centers. This has caused a change in case mix for hospitals as sicker patients are concentrated at hospitals for more complex surgeries. It appears that patients not suited for ASC care and those with lesser resources or less favored insurance status are being concentrated at hospitals which, by their mission, serve the wider community. In the hospital setting the revenue from surgical care as a percentage of total revenue may decrease as the payer mix changes.
The overarching factor in ASC growth is a desire to decrease healthcare costs. More favorable reimbursement policies favor the ASC setting. Commercial insurers, in search of cost savings, incentivize surgeons to increase ASC use. The CMS IPO list also continues a downward trend. According to Oakes, as reported by Catherman, “… we do know that when things come off the IPO list, they tend to migrate to the outpatient setting.”(5) Catherman reports that when total knee replacements were removed from the IPO list in 2018 the inpatient volume for this surgery declined nearly 18% with that volume going to the ASC market.5
The ASC surge does have some headwinds. Prolonged staffing shortages in anesthesia providers, perioperative nurses and surgical techs are also felt in ASCs that lack the resources, such as nurse educators, to develop much needed staff. Consumer preference for new technology also compels hefty capital equipment purchases for surgical robots and advanced imaging equipment straining the thin profit margins of ASCs.1,4 Adding new service lines is costly and may require facility expansion and renovation. Some smaller ASCs may be limited in their response to the need for large capital expenditures.
Collectively, hospitals are not standing pat in response to the shifting markets for surgical care. To keep up with the shift in care settings, hospitals will invest in ASC capacity either in new construction or by merger and acquisition. Long term we may see a re-positioning of where surgical care is delivered in this country. For now, the pendulum is swinging in favor of more surgical volume in ASCs, but that trend cannot continue exponentially. Surgery is a resource intensive process which necessitates innovation from stakeholders, The period of change in surgical care will continue for the near future and ASCs will surely figure prominently in that transition.
James X. Stobinski, Ph.D., RN, CNOR(E), CSSM(E), CNAMB(E), is a faculty member at Central Michigan University and director of hospital and ASC surgical education relationships with National Institute of First Assisting (NIFA).
References
- Sadler, D. (Winter, 2026) The ASC Surge. OR Today
- Grand View Research. (2026). U.S. Ambulatory Surgery Center market Size | Report, 2030. https://www.grandviewresearch.com/industry-analysis/us-ambulatory-surgery-centers-market-report
- Fortune – Business Insights (January 12, 2026). U.S. Ambulatory Surgical Centers Market Size, Share [2032]. https://www.fortunebusinessinsights.com/u-s-ambulatory-surgical-centers-market-106323
- VMG Health. (2026). ASC Leader Expectations A VMG Health Survey for 2026.
- Catherman, C. (2026, January 28). Hospital margins are threatened as surgeries move outpatient. Healthcare Brew. https://www.healthcare-brew.com/stories/2026/01/28/hospital-margins-threatened-surgeries-outpatient?mbcid=43841805.73370&mblid=a0883ad97b79&mid=8b4133a42575b45f50e047e1ff043e6a&utm_campaign=hcb&utm_medium=newsletter&utm_source=morning_brew
