A Safety and Cost Analysis of Outpatient Versus Inpatient Hindfoot Fusion Surgery

Abstract

Background. Hindfoot fusion procedures are increasingly being performed in the outpatient setting. However, the cost savings of these procedures compared with the risks and benefits has not been clearly investigated. The objective of this study was to compare patient characteristics, costs, and short-term complications between inpatient and outpatient procedures. Methods. This was a retrospective review of all patients who underwent inpatient and outpatient hindfoot fusion procedures by a single surgeon, at 1 academic institution, from 2013 to 2017. Data collected included demographics, operative variables, comorbidities, complications, costs, and subsequent reencounters. Results. Of 124 procedures, 34 were inpatient and 90 were outpatient. Between procedural settings, with the numbers available, there was no significant increase in complication rate or frequency of reencounters within 90 days. There were no significant differences in the number of patients with reencounters related to the index procedure within 90 days (P = .43). There were 30 reencounters within 90 days after outpatient surgery versus 4 after inpatient surgery (P = .05). The total number of emergency room visits in the outpatient group within 90 days was significantly higher compared with the inpatient group (P = .04). The average cost for outpatient procedures was US$4159 less than inpatient procedures (P < .0001). Conclusion. Outpatient hindfoot fusion may be a safe alternative to inpatient surgery, with significant overall cost savings and similar rate of short-term complications. On the basis of these findings, we believe that outpatient management is preferable for the majority of patients, but further investigation is warranted. Levels of Evidence: Level III

Pediatric Plastic Surgery Under Local Anesthesia

“…11 These include geographic location, procedure type, overhead costs, professional fees, and equipment usage, all of which contribute to greater costs when compared with office-based operations. [12][13][14] Performing office-based procedures under local anesthesia for the care of pediatric patients provides a possible means to decrease healthcare costs, while also avoiding complications arising from the use of general anesthesia in this population. 15,16 As such, the incorporation of local anesthesia cases into pediatric procedural practices is a means of expanding financial access of care to patients and their families in a safe manner.…”

“…Factors that affect the cost of operating room time have been described previously 11 . These include geographic location, procedure type, overhead costs, professional fees, and equipment usage, all of which contribute to greater costs when compared with office-based operations 12–14 . Performing office-based procedures under local anesthesia for the care of pediatric patients provides a possible means to decrease healthcare costs, while also avoiding complications arising from the use of general anesthesia in this population 15,16 .…”

Ambulantisierungspotenzial stationärer Fälle einer universitären Klinik für Orthopädie und Unfallchirurgie

“…Der medizinische Fortschritt ermöglicht die Durchführung vieler Operationen ambulant mindestens in gleicher, wenn nicht sogar in überlegener Qualität und zu geringeren Kosten als stationär [ 1 , 2 , 2 , 15 – 18 , 20 , 23 ]. Vorteile können medizinisch wissenschaftlich verortet sein, z.…”

“…Selbstredend sei an dieser Stelle auf wahrheitsgemäße Dokumentation hingewiesen, die aber vollständig sein muss, will man damit bei der MD-Begutachtung oder vor dem Sozialgericht Bestand haben. Jedoch zeigen bereits mehrere Studien, dass bereits die initiale operative Versorgung in einem ambulanten Setting durchgeführt werden kann [ 17 , 20 ].…”

Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons

“…Day-case foot and ankle surgery is known to be safe for the patient with high satisfaction rates as well as being cost effective for the service[ 11 ]. There is recent evidence showing there were little to no differences in complication rates or readmissions following foot/ankle surgeries (total ankle replacements, ankle fractures, total ankle arthroplasty and hindfoot fusions) that were performed as day-case vs inpatient[ 12 - 17 ]. However there are no specific guidelines for foot and ankle day-case surgery.…”