A study recently published in Stroke: Vascular and Interventional Neurology has found that diagnostic cerebral angiographies performed in the ambulatory setting can be completed more efficiently than those performed in a traditional hospital, highlighting how advances in neuroendovascular care are expanding the locations in which patients can safely receive treatment. Here, on behalf of their colleagues in the University at Buffalo Neurosurgery (UBNS; Buffalo, USA) endovascular research team, Rosalind Lai and Elad Levy discuss these findings and their broader significance.
Ambulatory surgery centres have transformed many areas of medicine, including ophthalmology, obstetrics and gynaecology, and general surgery. The concept emerged in the 1970s as physicians recognised that certain procedures could be performed safely outside the hospital in a more efficient setting. Since then, ambulatory surgery centres have expanded across many specialties by focusing on elective procedures for appropriately selected patients who do not require prolonged hospital stays. This shift has been made possible by advances in technology, anaesthesia and minimally invasive techniques.
Neurosurgery has been slower to adopt this model because many procedures historically required intensive monitoring and prolonged recovery. However, advances in neuroendovascular technology have changed this landscape. Many procedures—including the treatment of certain cerebral aneurysms—can now be performed minimally invasively through catheters. Some procedures that once required hospital admission can now be completed with patients safely returning home the same day. This raises an important question: can appropriately selected neuroendovascular procedures be performed in an outpatient surgery centre while maintaining the same high standard of patient care?
A new setting
Recognising this opportunity, we developed a dedicated ambulatory neuroendovascular programme in western New York to evaluate how neuroendovascular procedures could be delivered outside the traditional hospital setting for appropriately selected patients. The goal was not simply to create a different location of care delivery but, rather, to develop a model focused on efficiency and patient experience while maintaining the same rigorous standards of safety and quality as the hospital. Similar transitions have already occurred in other areas of neurosurgery, such as spine surgery. With advances in catheter technology, device design, procedural safety, and the increasing use of conscious sedation, neuroendovascular care represents the next frontier in this evolution.
To better understand whether this model could improve the delivery of neuroendovascular care, we evaluated the efficiency of procedures performed in the ambulatory centre compared with those performed in the traditional hospital. We reviewed patients who underwent elective neuroendovascular procedures at both our ambulatory surgery centre and the hospital between January and October 2024. We compared how efficiently each facility cared for patients by measuring how quickly one neuroendovascular procedure could begin after another (turnover time), the time at which the first procedure of the day started (first start time), and how long patients spent in the facility from arrival to discharge (total admission time).
“As procedures continue to become less invasive and technology continues to advance, more patients may benefit from receiving care at specialised centres designed around efficiency, accessibility and patient experience”
The differences were substantial. At the ambulatory surgery centre, the average time between procedures was just 12 minutes, compared with 31 minutes at the hospital. The first procedure of the day also started earlier, suggesting fewer delays and a more predictable schedule at the ambulatory surgery centre.
Why was the ambulatory surgery centre faster? Unlike traditional hospitals, which must constantly adjust schedules to accommodate emergency cases, ambulatory surgery centres primarily care for scheduled patients. The combination of dedicated staff and streamlined workflows helps procedures stay on schedule. Patients are also generally healthier and undergoing planned procedures, making their care more predictable.
We then asked what this meant for our patients. We compared 98 patients who underwent diagnostic cerebral angiography at the ambulatory surgery centre with 98 similar patients who had the same procedure at the hospital and went home the same day. We matched patients based on age, sex, past medical history and indication for the angiography. The difference was remarkable. Patients spent an average of nine hours at the hospital, while those who underwent the procedure at the ambulatory surgery centre spent 4.7 hours in the facility. In other words, patients had the same procedure completed and returned home in about half the time.
Real-world benefits
For patients, this means less waiting, fewer delays, and a more convenient experience—but the benefit extends beyond convenience. Less time before the procedure means patients spend less time waiting and worrying, reducing the stress that often accompanies a hospital visit. Earlier discharge allows patients to return to the comfort of their own homes sooner and spend less time away from their normal routines. Family members and caregivers also benefit from a more predictable schedule, fewer disruptions, and the ability to support their loved ones at home sooner.
For physicians and the healthcare team, this means a more efficient workflow and a more predictable schedule. Reducing unexpected delays can help decrease the burden and stress experienced by healthcare providers. This also benefits hospitals by allowing them to reserve valuable resources for patients who need a higher level of care, including those with complex medical conditions or emergency situations. By performing appropriate elective procedures in the ambulatory setting, hospitals can reduce delays and improve access to care.
Our study shows how advances in neuroendovascular care are making it possible to safely move selected procedures to the outpatient setting. Importantly, this is the first published study to directly compare the operational efficiency of neuroendovascular procedures performed in an ambulatory surgery centre with those performed in a hospital, providing early evidence for how outpatient neurointervention may reshape future care.
As procedures continue to become less invasive and technology continues to advance, more patients may benefit from receiving care at specialised centres designed around efficiency, accessibility and patient experience. Ultimately, the evolution of outpatient neurosurgical care represents a shift in healthcare delivery, improving efficiency while maintaining the highest standards of quality and safety.
Rosalind Lai is a cerebrovascular and endovascular neurosurgeon at UBNS, and assistant professor of neurosurgery at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo (Buffalo, USA).
Elad Levy is the L Nelson Hopkins professor and chair, director of endovascular fellowship and stroke service, and co-director of the Gates Stroke Center, at UBNS—and a State University of New York (SUNY) distinguished professor at the University at Buffalo (Buffalo, USA).
The authors declared no relevant disclosures or conflicts of interest.
