In the post-COVID era, ambulatory surgery centers (ASCs) are facing a confluence of challenges that threaten the stability of historically reliable margins. Staffing constraints—particularly among RNs, surgical techs, and anesthesia providers—are widespread. Supply chain disruptions continue to drive up the cost of surgical supplies, implants, and  pharmaceuticals. Inflation in utilities, rent, and outsourced services adds further pressure. Competitive wage demands, especially for clinical staff and CRNAs, are not matched by increases in reimbursement, tightening the squeeze.