Spinal surgery is undergoing a transformation, sparked by a marked increase in the number of procedures being performed in ambulatory surgery centers (ASCs) rather than hospitals. Between 2021 and 2024, the share of spinal surgeries conducted in ASCs rose by nearly 8% year-over-year. At the same time, orthopedic procedures are forecast to increase 12% in the next five years, and 22% over the next decade. These trends are likely driven by a combination of cost savings, advancements in surgical techniques, and evolving payer reimbursement policies.

The COVID-19 pandemic accelerated this shift, as ASCs were permitted to resume elective procedures earlier than hospitals in the spring of 2020. But ASC surgeries have since naturally increased largely due to provider and patient preferences (patients, in fact, report a 92% satisfaction rate with the care and service they receive from ASCs compared with a median 69.5% patient satisfaction rate in hospitals). Meanwhile, payers—including Medicare and private insurers—are expanding coverage for outpatient spinal procedures, reinforcing the economic viability of ASCs. With the continued innovation in surgical techniques and ASC-specific medical devices, outpatient spinal surgery seems primed to continue growing as an attractive alternative to traditional hospital-based care.

Yet despite the clear growth of ASCs overall, their adoption is not occurring uniformly across the country. Some states are seeing rapid growth in outpatient spinal surgery, while others are lagging. Regulatory policies, reimbursement structures, and investor interest may be contributing to this uneven growth. Even so, many medical device (medtech) companies are cautiously optimistic about what this trend could mean for their financial futures.

A Trend Started by COVID, Continued by Success

ASCs offer significant advantages for both patients and payers. Such facilities specialize in high-volume, routine procedures, allowing them to operate at significantly lower costs compared to a traditional hospital setting. On average, Medicare saves more than $4.2 billion annually when surgeries are performed at ASCs instead of hospital outpatient departments; likewise, Medicaid and other insurers benefit from lower prices for services performed in ASCs. In fact, ASCs can be at least 40% less costly than hospitals, according to three different studies where outpatient joint replacement surgeries cost $11,677, on average, compared with the same inpatient surgery costing $19,361.

Despite these potential cost savings, spinal surgery has historically been considered too complex for outpatient settings. New advancements in minimally invasive surgical techniques, improved anesthetic protocols, and enhanced post-operative recovery processes, however, now make it possible to conduct more spinal surgeries in ASCs.

Of the six spinal procedures examined in AcuityMD’s recent study, the results of which were presented at the American Academy of Orthopaedic Surgeons (AAOS) 2025 annual meeting, endoscopic disc decompression has been among the most widely performed procedures in the outpatient setting, started by the pandemic-era shift. Anterolateral spinal decompression surgery saw the fastest year-over-year growth from 2023 to 2024, suggesting that it may follow the trajectory of endoscopic decompression and become a standard ASC procedure too. These trends suggest that what began as a COVID-19 necessity is now becoming the norm, driven by financial incentives and patient preference.

“If the procedure can be done in a more cost-effective way, both the patient and payer can benefit,” said Jeremy Laynor, senior vice president of global sales for Providence Medical Technology. “Surgeons can also curate a more efficient day and oftentimes can own or invest in an ASC with partners.”

Surgeons investing in ASC ownership is a growing trend, with many ASCs having physician ownership and some even being solely physician-owned, offering potential financial benefits and operational expertise. A survey of academic spine surgeons found that 49% currently had investments in freestanding surgery centers—a stat that is expected to further blossom as ASC market expansion is projected to accelerate at a compound annual growth rate of 7.1% to $75 billion by 2030.

“Most people would be surprised at how little a surgeon makes from surgeries in hospitals,” said Dr. Alexander Sah, one of the nation’s top orthopedic surgeons specializing in joint replacement. He also serves as medical director at the Washington Outpatient Surgery Center and at Washington Hospital’s Institute for Joint Restoration.  “ASCs ownership offers significant financial incentive for surgeons across various therapeutic areas, but particularly in orthopedics where it is becoming increasingly more feasible to conduct successful procedures in outpatient settings.”

Geographic Disparity in Growth Rates

While there is a clear trend toward greater utilization of ASCs nationwide, the research also indicates that ASC growth is vastly different state-by-state. For example, Connecticut, Indiana, and North Carolina have experienced above-average ASC growth for spinal surgeries, while their neighbors, Massachusetts, Kentucky, and South Carolina have seen much slower growth. The reasons for these disparities are complex; no single regulatory or economic factor appears to fully account for them.

While it might be expected that Certificate of Need (CON) laws, which regulate healthcare facility expansion, play a role in these findings, AcuityMD data doesn’t show a correlation between CON laws and ASC adoption rates. This indicates that other factors are at play, such as provider preferences, payer policies, and local healthcare investment trends.

Dr. Sah believes ASC efficiency and specialization may play a significant role in their growth.

“With ASCs, there are opportunities to be procedure-specific,” said Dr. Sah. “They don’t have to be burdened by emergency surgeries, traumas, and other disruptions, so they can be really focused—like a mini specialty hospital. They can also be very efficient in scheduling and surgical execution, leading to more streamlined care.”

All of this underscores the need for further research to better understand the conditions that facilitate or hinder ASC expansion, and ensure that patients across every state can benefit from the advantages of procedures in ASC and other outpatient settings.

How Medtech Companies Are Responding

As more spinal procedures shift to ASCs, medtech companies are adjusting their commercial strategies to meet physician preferences. For example, by targeting ASCs, medtech companies can develop connections with physicians who also operate at larger hospital systems and independent delivery networks. As important, by understanding which doctors are operating at ASCs, companies can tailor their engagement strategies to get more innovative treatments to more patients, faster, for less, and in a setting many patients prefer.

“There’s a valuable opportunity for medtech companies to align their product with better patient experiences,” said Laynor. “If we can demonstrate improved outcomes, lower costs, or better patient experiences, it’s a win-win situation.”

Laynor cautioned that while ASCs present strong opportunities for medtech companies, success ultimately depends upon how well products align with ASC economics and procedural requirements.

“Medical products must fall in line with the surgeon’s desire to safely treat patients in this acute care environment while yielding a positive financial impact to the surgery center, as reimbursements are typically 40% lower than in the hospital,” explained Laynor.

Dr. Sah added that medtech companies hoping to reach ASC customers should take a highly targeted approach. “Smaller medtech companies that may have limited resources should be careful not to spread their commercial outreach too thin across the hundreds of ASCs nationwide,” Dr. Sah explained. “Use data to focus on the top performers, identify the high-volume centers, and tailor your strategy for real impact.”

Challenges to Continued Increases of ASC Procedures

Despite clear advantages, ASCs still encounter significant hurdles to broader adoption—especially with spinal procedures.

“ASCs must remain financially viable, and that means staying busy,” Dr. Sah said. “Hospitals cover overhead by spreading costs across more cases, while ASCs rely on volume and efficiency to succeed.”

One of the most pressing challenges facing ASCs in their quest for volume and efficiency is adequately trained staff. For example, scrub technicians must be proficient in spinal-specific techniques to maintain both safety and procedural efficiency.

Another hurdle is access to the right equipment, such as the Jackson table—a specialized surgical platform essential for many spinal procedures—especially considering ASC operating rooms are often smaller than those in hospitals. Without key tools like these, performing certain spine surgeries safely and effectively in an outpatient setting can be challenging, if not unfeasible.

Laynor also noted that, given the lower reimbursement rates from hospitals, cost constraints can present a key challenge for medtech companies trying to sell into ASC environments.

“These lower reimbursement models are one of the primary challenges that a medical device company may face, as the typical ASC will need lower price points to meet the requirements of a positive margin for the same procedure at the hospital,” Laynor said.

Driving Future Growth

While headwinds remain, the overall trajectory for ASC utilization is moving in the right direction.

Reimbursement policies, continued innovation, and supportive regulations are all trending in their favor. Physicians continue to refine minimally invasive techniques, which make outpatient spinal surgeries safer and more feasible, while medtech companies are developing devices specifically designed for ASC settings. Another reason to be optimistic about ASC trends is the tight correlation between clinical and financial incentives for physicians.

“There are real incentives at ASCs,” Dr. Sah explained. “ASC surgeons often have skin in the game because they are financially invested, so they evaluate new technologies more carefully. If they see something that will help improve outcomes and the bottom line, they’ll adopt it. That’s not always the case in hospitals, where those making the decisions aren’t directly affected and there can be many layers of bureaucracy to jump through for a medtech sales rep.”

Dr. Sah added, “And while it’s true that ASCs operate with a leaner, more focused approach motivated in part by efficiency, they must ensure cost savings don’t come at the expense of patient outcomes.”

Laynor believes that innovation is what will ultimately lead to greater ASC adoption.

“As technology continues to advance, more spinal conditions and procedural solutions will fit into this lower-risk category—examples of advanced technology include minimally invasive approaches, enhanced surgical planning platforms, and visualization techniques that allow for direct access to affected anatomy,” he said.

Dr. Sah concluded, “Orthopedic outpatient surgeries will only continue to increase, especially with hip and knee replacements, but also in more complicated procedures like spinal surgeries. The more procedures that move to ASCs, the confidence raises for others, and it will be like a domino effect.”

While ASCs might currently be growing at an uneven rate across the United States, the data is clear that ASC surgery is on the rise and poised to deliver financial and clinical benefits for patients, providers, and payers alike. As the industry continues to make this shift, medtech companies, policymakers, and healthcare providers should harness these new insights and drive strategies that will maximize the benefits of ASCs equitably nationwide.