Ambulatory cleft lip surgery: A value analysis

Arneja, Jugpal S.; Mitton, Craig

doi:10.4172/plastic-surgery.1000830

Cited by 6 publications

(5 citation statements)

References 5 publications

(8 reference statements)

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“…Doing so improves healthcare value by decreasing the opportunity cost of the clinic visit at no detriment to the patient. 13 , 14 Furthermore, a recent study by Fuschini et al 15 evaluated the management of simple orthopedic fractures in the primary care setting without visits to an orthopedic clinic. These injuries included volar plate avulsions, proximal phalanx, and metacarpal fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Future research should determine criteria for referral such that these uncomplicated patients may be followed in a primary care or sports medicine clinic which may be more convenient for the family without added risk. Furthermore, healthcare value will be enhanced as the opportunity cost always falls toward urgent/emergent referrals 13 , 14 ; by decreasing demand for outpatient clinic access in our high resource utilization Canadian healthcare system, another long waiting elective patient can be prioritized for access.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Hand Fracture Outcomes: How Often Do We Need to Operate?

et al. 2022

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Purpose: Pediatric hand fractures are frequent presentations to the emergency department. This study set out to evaluate the epidemiology, management, and outcomes, where care was imparted and by whom, and offer resource utilization suggestions regarding pediatric fractures presenting to a Canadian pediatric hospital. Methods: Records of patients from 0 to 18 years of age who presented to the British Columbia Children’s Hospital Emergency Department between November 1, 2016, and January 31, 2021, with metacarpal or phalangeal fractures were analyzed. Results: A total of 524 hand fractures were identified in 499 patients. Over 60% of fractures occurred in boys. The number of fractures peaked at the age of 11 years for girls and 12 years for boys. Open fractures accounted for only 4.0% of all fractures. Approximately 40% of fractures were epiphyseal growth plate fractures, with Salter-Harris II fractures being the most common diagnosis overall. Management was primarily nonsurgical, with 75% of fractures managed with immobilization alone and 23% of fractures managed with bedside closed reduction and immobilization. Of the fractures requiring closed reduction, the majority were performed by the emergency physician with a success rate of 82%. Only 2.3% of all fractures required surgery. Conclusions: Hand fractures are common pediatric injuries and make up a large proportion of emergency room visits. The majority of fractures do not require formal surgery and are well managed with immobilization alone or closed reduction by an emergency room physician and immobilization. Nonsurgical treatment offers very encouraging outcomes. A certain percentage of these simple fractures would likely benefit from primary care management alone and not require specialist intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pediatric Hand Fracture Outcomes: How Often Do We Need to Operate?

et al. 2022

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“…The mean direct medical costs for cleft palate were derived by value analysis of published articles related to ambulatory cleft lip repair over 30 years. 31 The mean cost per person in Canada and the United States ranged from $1800 to $2,390. For hypospadias or genitourinary complications, we used Australian-specific data for different codes 32 (displayed in Supplement, eAppendix 5, links.lww.com/WNL/C512).…”

Section: Health Care and Indirect Costs For Adverse Pregnancy Outcomesmentioning

confidence: 99%

Economic Evaluation of the Community Benefit of the Australian Pregnancy Register of Antiseizure Medications

et al. 2023

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Background and Objective:The Raoul Wallenberg Australian Pregnancy Register (APR) was established to collect, analyse and publish data on the risks to babies exposed to anti-seizure medications (ASMs), and to facilitate quality improvements in management care over time. It is one of several prospective observational pregnancy registers of ASMs that has been established around the world. While the APR and other registries have contributed to knowledge gain that has been applied to decrease adverse pregnancy outcomes, their cost-effectiveness remains unknown. Here we aimed to evaluate the economic impacts of the APR from both societal and healthcare system perspectives.Methods:Using decision-analytic modelling, we estimated the effectiveness (prevention of adverse pregnancy outcomes) and costs (costs of adverse pregnancy outcomes and the register itself) of the APR over a 20-year time horizon (2000-2019). The comparator was set as the adverse pregnancy outcomes collected by the APR between 1998 and 2002 (i.e., no APR derived improvements in care). In the scenario analysis we conservatively assumed a 2.5% and 5% contribution of the APR to the savings in healthcare and societal costs. Adverse pregnancy outcomes included stillbirth, birth defects and induced abortion. All cost data were derived from published sources. Health and economic outcomes were extrapolated to the total target Australian epilepsy population. The primary outcomes of interest were the return of investment (ROI) for the APR and incremental cost-effectiveness ratio (ICER) in terms of cost per adverse outcome avoided.Results:Over the 20-year time horizon, the ROI from the APR from a societal perspective was AUD 2,250 (i.e. every dollar spent on the program resulted in a return of AUD2,250). Over this time, it was estimated that 9,609 adverse pregnancy outcomes were avoided, and healthcare and societal costs were reduced by AUD 191 million and AUD 9.0 billion, respectively. Hence from a health economic point of view, the APR was dominant, providing cost-saving ICERs from both perspectives.Conclusion:Following its inception 20+ years ago, the APR has represented excellent value for investment for Australia, being also health-saving and cost-saving from a societal and a healthcare perspective. With the growing number of marketed ASMs, the APR is expected to continue to have a major impact in the foreseeable future.

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“…It has been reported that overnight admission following cleft lip surgery can cost patients an estimated $2930 and that admitting patients with select, predictive postoperative risk factors may result in a national savings of $8.7 million per year. 3,4 In addition to reducing costs, safety considerations of outpatient cleft surgery have been well described. To be considered a good candidate for ambulatory cleft lip repair, patients should meet specific discharge criteria such as ability to tolerate an oral diet early in the postoperative period.…”

Section: Introductionmentioning

confidence: 99%

Cleft Lip and Palate Care: A Healthcare Cost and Utilization Project Analysis

Khoo

Lopez

Perla

et al. 2023

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Introduction: Increasing emphasis on reduction of healthcare costs has caused rates of outpatient cleft lip and palate-related procedures to rise. This study aims to describe patient and hospital characteristics associated with cleft repair and related surgeries and to assess differences in these characteristics against those undergoing inpatient cleft procedures. Methods: Data was collected from the 2016 to 2018 National Inpatient Sample (NIS) and the 2016 to 2018 Nationwide Ambulatory Surgery Sample (NASS) from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ). The databases were queried for International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and Current Procedural Terminology (CPT) codes, respectively, describing cleft lip and palate-related procedures. Variables described were categorized into 2 main groups of patient demographics and hospital characteristics. Results: A total of 271 patients were included from the NIS and 3122 patients from the NASS. In both settings, the most common insurance used for cleft lip surgeries was Medicaid (46.7% vs 50.7%); the same was true for cleft palate (50.7% vs 53.5%). The distribution of zip code-based income quartiles was similar between settings for both cleft procedures. The most common location and teaching status of the hospitals was urban, teaching hospitals. Conclusion: This study demonstrates that patient and hospital characteristics are similar between inpatient and outpatient cleft surgeries. Patients were primarily in the 2 lower income quartiles and enrolled in Medicaid. More granular studies defining the social determinants of health in the cleft lip and palate populations may improve care for these patients.

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Ambulatory cleft lip surgery: A value analysis

Cited by 6 publications

References 5 publications

Pediatric Hand Fracture Outcomes: How Often Do We Need to Operate?

Pediatric Hand Fracture Outcomes: How Often Do We Need to Operate?

Economic Evaluation of the Community Benefit of the Australian Pregnancy Register of Antiseizure Medications

Cleft Lip and Palate Care: A Healthcare Cost and Utilization Project Analysis

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