Ambulatory versus inpatient shoulder arthroplasty: a population-based analysis of trends, outcomes, and charges

Ode, Gabriella E.; Odum, Susan M.; Connor, Patrick M.; Hamid, Nady

doi:10.1016/j.jses.2019.10.001

Cited by 52 publications

(72 citation statements)

References 19 publications

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“…Eight [ 8 , 16 , 17 , 19 , 25 – 28 ] out of the ten studies reported readmission rates and nine studies reported postoperative complications. Two studies [ 8 , 25 ] reported costs in the form of total charges or cost per patient, and one study [ 18 ] reported shoulder functional scores. The summary of the included studies is provided in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…In the most recent study by Ode et al [ 25 ], the charges including surgery costs and the episode of care were compared across five states. They found that the outpatient setting has resulted in a 40% decrease in charges with the state where the surgery has been performed was the strongest predictor.…”

Section: Resultsmentioning

confidence: 99%

“…Of interest, Cancienne et al [ 8 ] reported in their matched-cohort on a national insurance database that risk factors for re-admissions within 90 days include obesity, diabetes mellitus, peripheral vascular disease, congestive heart failure, chronic lung disease, depression, and chronic anemia in both outpatient and inpatient groups. In another database study, Ode et al [ 25 ] performed logistic regression analysis and found that readmissions were markedly increased in obese patients and were also strongly affected by the state that the procedure was performed.…”

Section: Discussionmentioning

confidence: 99%

“…The total number of the population included was 199,662 cases of TSAs, with 7637 (3.8%) patients who underwent outpatient TSAs, and 192,025 (96.2%) patients underwent inpatient TSAs. Eight [8,16,17,19,[25][26][27][28] out of the ten studies reported readmission rates and nine studies reported postoperative complications. Two studies [8,25] reported costs in the form of total charges or cost per patient, and one study [18] reported shoulder functional scores.…”

Section: Study Characteristicsmentioning

confidence: 99%

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The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis

Ahmed

Hantouly

Toubasi

et al. 2021

International Orthopaedics (SICOT)

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Purpose To meet the increasing demands of total shoulder arthroplasty (TSA) while reducing its financial burden, there has been a shift toward outpatient surgery. This systematic review and meta-analysis aimed to evaluate the safety of outpatient TSA. Methods The primary objective was to compare re-admission rates and postoperative complications in outpatient versus inpatient TSA. The secondary objectives were functional outcomes and costs. PubMed, Google Scholar, and Web of Science were searched until March 28, 2020. The inclusion criteria were studies reporting at least complications or readmission rates within a period of 30 days or more. Results Ten level III retrospective studies were included with 7637 (3.8%) and 192,025 (96.2%) patients underwent outpatient and inpatient TSA, respectively. Outpatient TSA had relatively younger and healthier patients. There were no differences between outpatient and inpatient arthroplasty for 30- and 90-day readmissions. Furthermore, unadjusted comparisons demonstrated significantly less total and major surgical complications, less total, major, and minor medical complications in favour of outpatient TSA. However, subgroup analyses demonstrated that there were no significant differences in all complication if the studies had matched controls and regardless of data source (database or nondatabase studies). The revision rates were similar between both groups at a 12–24 months follow-up. Two studies reported a significant reduction in costs in favour of outpatient TSA. Conclusion This study highlights that outpatient TSA could be a safe and effective alternative to inpatient TSA in appropriately selected patients. It was evident that outpatient TSA does not lead to increased readmissions, complications, or revision rates. A potential additional benefit of outpatient TSA was cost reduction.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis

Ahmed

Hantouly

Toubasi

et al. 2021

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…Therefore, it should not be concluded that an inpatient hospital stay is not more costly. Although prior studies have shown increased costs associated with a main hospital setting compared to ambulatory surgical centers, 31 , 32 we were unable to explore the effect of this variable as only 1 patient that had surgery at our ambulatory surgical center. We also did not observe a difference in surgical costs whether a formal ulnar nerve transposition was performed or not.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of factors driving cost variation for distal humerus open reduction internal fixation

Zeidan¹,

Stephens²,

Zhang³

et al. 2021

JSES International

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Background Distal humerus fracture open reduction and internal fixation (ORIF) represents a substantial cost burden to the health care system. The purpose of this study was to describe surgical encounter cost variation for distal humerus ORIF, and to determine demographic-, injury-, and treatment-specific factors that influence cost. Methods We retrospectively identified adult patients (≥18 years) treated for isolated distal humerus fractures between July 2014 and July 2019 at a single tertiary academic referral center. For each case, surgical encounter total direct costs (SETDCs) were obtained via our institution's information technology value tools, which prospectively record granular direct cost data for every health care encounter. Costs were converted to 2019 dollars using the personal consumption expenditure indices for health and summarized with descriptive statistics. Univariate and multivariate linear regression models were used to identify factors influencing SETDC. Results Surgical costs varied widely for the 47 included patients, with a standard deviation (SD) of 33% and interquartile range of 76%-124% relative to the mean SETDC. Implant and facility costs were responsible for 46.2% and 32.6% of the SETDC, respectively. Implant costs also varied considerably, with an SD of 21% and range from 13%-36% relative to the mean SETDC. Multivariate analysis demonstrated that SETDC increased 24% ( P < .001) on performing an olecranon osteotomy, and by 15% for each additional 1 hour of surgical time ( P < .001). These findings were independent of age, sex, body mass index, open fracture, need for an additional small plate construct as a reduction aid, and fracture pattern (all insignificant in the multivariate analysis, with P >.05 for each factor). Conclusion Substantial variations in surgical encounter total direct costs for distal humerus ORIF exist, as do wide variations in associated implant costs that comprise nearly half of the entire surgical cost. Performing an olecranon osteotomy, and increased surgical time, significantly increased surgical costs. Although use of an olecranon osteotomy may not be a completely controllable factor as it is confounded by fracture severity and operative time, this may suggest that surgeons should try to use an olecranon osteotomy judiciously. Although complexity of the fracture pattern was statistically insignificant, it is confounded by the need for an olecranon osteotomy and increased surgical time and likely is a clinically relevant and nonmodifiable driver of surgical cost. These findings highlight opportunities to reduce cost variation, and potentially improve the value of care, for distal humerus ORIF patients.

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Medicare Eligibility and Racial and Ethnic Disparities in Operative Fixation for Distal Radius Fracture

Benítez,

Ouyang,

Khouri

et al. 2023

JAMA Netw Open

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ImportanceMedicare provides near-universal health insurance to US residents aged 65 years or older. How eligibility for Medicare coverage affects racial and ethnic disparities in operative management after orthopedic trauma is poorly understood.ObjectiveTo assess the association of Medicare eligibility with racial and ethnic disparities in open reduction and internal fixation (ORIF) after distal radius fracture (DRF).Design, Setting, and ParticipantsThis retrospective cohort study with a regression discontinuity design obtained data from the Healthcare Cost and Utilization Project all-payer statewide databases for Florida, Maryland, and New York. These databases contain encounter-level data and unique patient identifiers for longitudinal follow-up across emergency departments, outpatient surgical centers, and hospitals. The cohort included patients aged 57 to 72 years who sustained DRFs between January 1, 2016, and November 30, 2019. Data analysis was performed between March 1 and October 15, 2023.ExposureEligibility for Medicare coverage at age 65 years.Main Outcomes and MeasuresType of management for DRF (closed treatment, external fixation, percutaneous pinning, and ORIF). Time to surgery was ascertained in patients undergoing ORIF. Multivariable logistic regression and regression discontinuity design were used to compare racial and ethnic disparities in patients who underwent ORIF before or after age 65 years.ResultsA total of 26 874 patients with DRF were included (mean [SD] age, 64.6 [4.6] years; 22 359 were females [83.2%]). Of these patients, 2805 were Hispanic or Latino (10.4%; hereafter, Hispanic), 1492 were non-Hispanic Black (5.6%; hereafter, Black), and 20 548 were non-Hispanic White (76.5%; hereafter, White) and 2029 (7.6%) were individuals of other races and ethnicities (including Asian or Pacific Islander, Native American, and other races). Overall, 32.6% of patients received ORIF but significantly lower use was observed in Black (20.2% vs 35.4%; P &lt; .001) and Hispanic (25.8% vs 35.4%; P &lt; .001) patients compared with White individuals. After adjusting for potential confounders, multivariable logistic regression analysis confirmed the disparity in ORIF use in Black (odds ratio [OR], 0.60; 95% CI, 0.50-0.72) and Hispanic patients (OR, 0.82; 95% CI, 0.72-0.94) compared with White patients. No significant difference in ORIF use was found among racial and ethnic groups at age 65 years. The expected disparity in ORIF use between White and Black patients at age 65 years without Medicare coverage was 12.6 percentage points; however, the actual disparity was 22.0 percentage points, 9.4 percentage points (95% CI, 0.3-18.4 percentage points) greater than expected, a 75% increase (P = .04). In the absence of Medicare coverage, the expected disparity in ORIF use between White and Hispanic patients was 8.3 percentage points, and this result persisted without significant change in the presence of Medicare coverage.Conclusions and RelevanceResults of this study showed that surgical management for DRF was popular in adults aged 57 to 72 years, but there was lower ORIF use in racial or ethnic minority patients. Medicare eligibility at age 65 years did not attenuate race and ethnicity–based disparities in surgical management of DRFs.

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Ambulatory versus inpatient shoulder arthroplasty: a population-based analysis of trends, outcomes, and charges

Cited by 52 publications

References 19 publications

The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis

The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis

Evaluation of factors driving cost variation for distal humerus open reduction internal fixation

Medicare Eligibility and Racial and Ethnic Disparities in Operative Fixation for Distal Radius Fracture

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