Effect of Facility on the Operative Costs of Distal Radius Fractures

Mather, Richard C.; Wysocki, Robert; Aldridge, J. Mack; Pietrobon, Ricardo; Nunley, James A.

doi:10.1016/j.jhsa.2011.03.042

Cited by 24 publications

(14 citation statements)

References 27 publications

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“… 6 Mather and colleagues (2011) found that the difference in cost of in-and outpatient operative repair of distal radius fracture using a volar plate was unaffected by ASA status, bone graft, carpal tunnel release, gender, age, surgeon experience, or fracture severity. 12 Lovald and colleagues (2014) found that the incremental payments for osteoarthritis attributable costs at 2 years were lowest for the outpatient group and increased for in-hospital stays (of 1 day or longer). 11 Aynardi and colleagues (2014) found that patients who underwent outpatient surgery reported more complications (although this did not reach statistical significance and included post-operative desaturations, intraoperative EKG changes and intra-operative non-displaced cal-car femorale fractures) but incurred significantly less final cost than the inpatient cohort.…”

Section: Resultsmentioning

confidence: 99%

Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: a systematic review of the published literature

Crawford

Sprague

et al. 2015

Orthop Rev

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The number of outpatient orthopedic surgeries performed within North America continues to increase. The impact of this change in services on patient outcomes is largely unknown. The objective of this review is to compare patient outcomes and associated costs for outpatient orthopedic surgeries traditionally performed in hospital to inpatient surgeries, as well as to summarize the eligibility and preoperative education requirements for outpatient orthopedic surgery in North America. We performed a systematic review of Medline, Pubmed and Embase databases for articles comparing the clinical and economic impact of outpatient orthopedic surgical procedures versus inpatient procedures in North America. We reported on requirements for inpatient versus outpatient care, preoperative education requirements, complications and patient outcomes, patient satisfaction, and when available total mean costs. Nine studies met the inclusion criteria for this review. Eligibility requirements for outpatient orthopedic surgery within the included studies varied, but generally included: patient consent, a caregiver at home following surgery, close proximity to an outpatient center, and no history of serious medical problems. Preoperative education programs were not always compulsory and practices varied between outpatient centers. All of the reviewed studies reported that outpatient surgeries had similar or improved level of pain and rates of nausea. Outpatients reported increased satisfaction with the care they received. As expected, outpatient procedures were less expensive than inpatient procedures. This review found that outpatient procedures in North America appear to be less expensive and safe alternatives to inpatient care for patients who are at lower risk for complications and procedures that do not necessarily require close hospital level care monitoring following same day surgery.

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Section: Resultsmentioning

confidence: 99%

Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: a systematic review of the published literature

Crawford

Sprague

et al. 2015

Orthop Rev

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“…In total, three studies reported on 30-day readmission 2,11,18 and were determined to be comparable for the meta-analysis. 8,14,17 Following meta-analysis, there was no significant difference seen among patients who underwent day case TSA compared to inpatient (OR: 0.940; 95% CI: 0.723–1.223; p = 0.646; Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…The shift toward performing orthopedic surgical procedures in the day case setting and in ambulatory surgical centers is a recognized trend of the last 20 years, while a multitude of patient, surgeon, and facility factors have led to the explosive growth of the day case model. 1–4 Policymakers and hospitals are frequently looking at length of stay (LOS) after surgery as an area of focus for improvement, with recent interest in day case total joint arthroplasty. 5 Overall, improved surgical techniques, pain management, and perioperative patient management have led to declining LOS.…”

Section: Introductionmentioning

confidence: 99%

Day case versus inpatient total shoulder arthroplasty: A systematic review and meta-analysis

Malahias

Kokkineli

et al. 2020

Shoulder & Elbow

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Background A number of papers have been published comparing the safety and efficacy of day case and inpatient anatomic or reverse total shoulder arthroplasty. However, no systematic review of the literature has been published to date. The aim of this review was to determine if day case total shoulder arthroplasty (length of stay <24 h) leads to similar outcomes as standard-stay inpatients (length of stay ≥24 h). Methods The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviewers were queried for publications utilizing keywords that were pertinent to total shoulder arthroplasty, day case, outpatient and inpatient, clinical or functional outcomes, and complications. In order to determine the quantitative impact of day case total shoulder arthroplasty on readmission and revision rate, a meta-analysis was performed on articles that observed 30- or 90-day readmission or revision. Results Eight articles were found to be suitable for inclusion in the present study which included 6103 day case total shoulder arthroplasty and 147,463 inpatient total shoulder arthroplasty. Following meta-analysis, there was no significant difference among patients who underwent day case total shoulder arthroplasty compared to inpatient total shoulder arthroplasty regarding revision rates (OR: 1.001; 95% CI: 0.721–1.389; p = 0.995) and 30-day readmission rates (OR: 0.940; 95% CI: 0.723–1.223; p = 0.646). In contrast, patients who underwent day case total shoulder arthroplasty were less likely to have a readmission within 90 days compared to their inpatient counterparts (OR: 0.839; 95% CI: 0.704–0.999; p = 0.049). Two out of eight studies reported comparable baseline clinical characteristics among groups, while five studies reported significant differences and one study did not provide information regarding clinical characteristics, such as medical comorbidities or American Society of Anaesthesiologists'(ASA) score. No significant difference among groups was found in all or almost all studies regarding mortality rates, and rates of cardiac complications, cerebrovascular events, thromboembolic events, pulmonary complications, cardiac complications, and nerve complications. Finally, results were rather conflicting regarding the correlation of day case total shoulder arthroplasty to the rate of surgical site infections. Conclusions This study showed that day case total shoulder arthroplasty might lead to similar rates of mortality, complications, revisions, and readmissions compared to inpatient total shoulder arthroplasty when used in a selected population of younger, healthier, and more male patients. In contrast, there was no consensus regarding the impact of day case total shoulder arthroplasty on the rate of surgical site infections. Finally, further research of higher quality is required to establish patient demographic criteria, ASA score, or comorbidity index cut off that might be used to define day case-treated patients who seem to have equivalent outcomes compared to inpatient-treated patients. Level of evidence: Systematic review of level III studies (lowest level included).

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“…23 Additionally, these surgeries should be performed at ambulatory surgical facilities when possible, as they have been shown to have lower mean operative costs per case compared to inpatient facilities. 21…”

Section: Discussionmentioning

confidence: 99%

“…Studies have assessed the outcomes and costs of distal radius fracture management relative to the type of operative intervention, implants, facility, and post-injury management. [17][18][19][20][21][22][23] However, there is a paucity of literature that risk stratifies patients and evaluates outcomes and costs relative to risk group. Given that middle-aged and geriatric patients are more likely to have expensive hospitalizations owing to increased admissions, longer length of stays, and more complications, 24,25 risk stratification on admission can aid physicians in counseling patients regarding outcomes and improve resource allocation.…”

Section: Introductionmentioning

confidence: 99%

Ability of a Risk Prediction Tool to Stratify Quality and Cost for Older Patients With Operative Distal Radius Fractures

Adenikinju

Ranson

Rettig

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: Distal radius fractures are the second most common fracture in the elderly population. The incidence of these fractures has increased over time, and is projected to continue to do so. The aim of this study is to utilize a validated trauma risk prediction tool to stratify middle-aged and geriatric patients with operative distal radius fractures as well as compare hospital quality metrics and inpatient hospitalization costs among the risk groups. Materials and Methods: Patients were prospectively enrolled in an orthopedic trauma registry. The Score for Trauma Triage in Geriatric and Middle Aged (STTGMA) was calculated using patient demographics, injury severity, and functional status. Patients were then stratified into minimal-risk, moderate-risk, and high-risk cohorts based on their scores. Length of stay, need for escalation of care, complications, mortality, discharge location, 1-year patient reported outcomes, and index admission costs were evaluated. Results: Ninety-two patients met inclusion criteria. Sixty-three (68.5%) patients were managed with outpatient surgery. The mean inpatient length of stay for the high-risk cohort was 2.9x and 2.2x higher than the minimal and moderate-risk cohorts, respectively (2.0 + 2.9 days vs. 0.7 + 0.9 and 0.9 + 1.1 days, P = .019). There were no complications or mortality in any of the risk groups. No patients required intensive care and all patients were discharged home. There was no difference in readmission rates, inpatient cost, or 1-year patient reported outcomes among the risk cohorts. Discussion/Conclusions: The Score for Trauma Triage in Geriatric and Middle-Aged is able to risk-stratify patients that undergo operative intervention of distal radius fractures. Middle aged and elderly patients with isolated closed distal radius fractures can be safely managed on an outpatient basis regardless of risk. Standardized pathways can be created in the management of these injuries, thereby optimizing value-based care. Level of evidence: Prognostic Level III

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Effect of Facility on the Operative Costs of Distal Radius Fractures

Cited by 24 publications

References 27 publications

Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: a systematic review of the published literature

Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: a systematic review of the published literature

Day case versus inpatient total shoulder arthroplasty: A systematic review and meta-analysis

Ability of a Risk Prediction Tool to Stratify Quality and Cost for Older Patients With Operative Distal Radius Fractures

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