1
|
Derks LSM, Smit AL, Thomeer HGXM, Grolman W, Stokroos RJ, Wegner I. The cost evaluation of day-case compared to inpatient cochlear implantation in adults: subanalysis of a randomized controlled trial. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08501-7. [PMID: 38528216 DOI: 10.1007/s00405-024-08501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/24/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To investigate the assumption that day-case cochlear implantation is associated with lower costs, compared to inpatient cochlear implantation, while maintaining equal quality of life (QoL) and hearing outcomes, for the Dutch healthcare setting. STUDY DESIGN A single-center, non-blinded, randomized controlled trial in a tertiary referral center. METHODS Thirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group (i.e., one night admission). We performed an intention-to-treat evaluation of the difference of the total health care-related costs, hospital and out of hospital costs, between day-case and inpatient cochlear implantation, from a hospital and patient perspective over the course of one year. Audiometric outcomes, assessed using CVC scores, and QoL, assessed using the EQ-5D and HUI3 questionnaires, were taken into account. RESULTS There were two drop-outs. The total health care-related costs were €41,828 in the inpatient group (n = 14) and €42,710 in the day-case group (n = 14). The mean postoperative hospital stay was 1.2 days (mean costs of €1,069) in the inpatient group and 0.7 days (mean costs of €701) for the day-case group. There were no statistically significant differences in postoperative hospital and out of hospital costs. The QoL at 2 months and 1 year postoperative, measured by the EQ-5D index value and HUI3 showed no statistically significant difference. The EQ-5D VAS score measured at 1 year postoperatively was statistically significantly higher in the inpatient group (84/100) than in the day-case group (65/100). There were no differences in postoperative complications, objective hearing outcomes, and number of postoperative hospital and out of hospital visits. CONCLUSION A day-case approach to cochlear implant surgery does not result in a statistically significant reduction of health care-related costs compared to an inpatient approach and does not affect the surgical outcome (complications and objective hearing measurements), QoL, and postoperative course (number of postoperative hospital and out of hospital visits). LEVEL OF EVIDENCE: 1
Collapse
Affiliation(s)
- Laura S M Derks
- Department of Otorhinolaryngology-Head and Neck Surgery, G05.129, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Adriana L Smit
- Department of Otorhinolaryngology-Head and Neck Surgery, G05.129, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology-Head and Neck Surgery, G05.129, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wilko Grolman
- Jean Causse Ear Clinic, Traverse de Béziers, Colombiers, France
| | - Robert J Stokroos
- Department of Otorhinolaryngology-Head and Neck Surgery, G05.129, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
2
|
Agarwal AR, Wang KY, Xu AL, Ramamurti P, Zhao A, Best MJ, Srikumaran U. Outpatient Versus Inpatient Total Shoulder Arthroplasty: A Matched Cohort Analysis of Postoperative Complications, Surgical Outcomes, and Reimbursements. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202311000-00010. [PMID: 37973033 PMCID: PMC10656088 DOI: 10.5435/jaaosglobal-d-23-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION There has been a trend toward performing arthroplasty in the ambulatory setting. The primary purpose of this study was to compare outpatient and inpatient total shoulder arthroplasties (TSAs) for postoperative medical complications, healthcare utilization outcomes, and surgical outcomes. METHODS Patients who underwent outpatient TSA or inpatient TSA with a minimum 5-year follow-up were identified in the PearlDiver database. These cohorts were propensity-matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index > 30). All outcomes were analyzed using chi square and Student t-tests where appropriate. RESULTS Outpatient TSA patients had markedly lower rates of various 90-day medical complications. Outpatient TSA patients had lower risk of aseptic loosening at 2 years postoperation and lower risk of periprosthetic joint infection at 5 years postoperation relative to inpatient TSA patients. Outpatient TSA reimbursements were markedly lower than inpatient TSA reimbursements at the 30-day, 90-day, and 1-year postoperative intervals. CONCLUSION This study found patients undergoing outpatient TSA to be at lowers odds for both postoperative medical and surgical complications compared with those undergoing inpatient TSA. Despite increased risk of postoperative healthcare utilization for readmissions and emergency department visits, outpatient TSA was markedly less expensive at every postoperative time point assessed.
Collapse
Affiliation(s)
- Amil R. Agarwal
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Kevin Y. Wang
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Amy L. Xu
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Pradip Ramamurti
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Amy Zhao
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Matthew J. Best
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| | - Uma Srikumaran
- From the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Mr. Agarwal, Dr. Xu, Dr. Best, and Dr. Srikumaran); the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC (Mr. Agarwal and Ms. Zhao); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wang); and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Ramamurti)
| |
Collapse
|
3
|
Allen J, Abdelmonem M, Fieraru G, Guyver P. Introducing A Day-Case Shoulder Arthroplasty Pathway In The UK - How We Did It. Shoulder Elbow 2023; 15:311-320. [PMID: 37325384 PMCID: PMC10268136 DOI: 10.1177/17585732221079582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 09/20/2023]
Abstract
Background As the demand for elective orthopaedics grows, day-case arthroplasty is gaining popularity. The aim of this study was to create a safe and reproducible pathway for day-case shoulder arthroplasty (DCSA) based upon a literature review and discussion with the local multidisciplinary team (MDT). Methods A literature review was performed using OVID MEDLINE and Embase databases reporting 90-day complication and admission rates following DCSA. Minimum follow-up was 30 days. Day-case was defined as discharge on the same day of surgery. Results The literature review revealed a mean 90-day complication rate of 7.7% [range, 0-15.9%] and mean 90-day readmission rate of 2.5% [range 0-9.3%]. A pilot protocol was devised based upon the literature review and consisted of 5 phases: (1) pre-operative assessment, (2) intra-operative phase, (3) post-operative phase, (4) follow-up, and (5) readmission protocol. This was presented, discussed, amended, and ultimately ratified by the local MDT. In May 2021 the unit successfully completed its first day-case shoulder arthroplasty. Discussion This study proposes a safe and reproducible pathway for DCSA. Patient selection, well-defined protocols and communication within the MDT are important factors to achieve this. Further studies with extended follow-up will be needed to gauge long-term success within our unit.
Collapse
Affiliation(s)
- James Allen
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
- Huddersfield Royal Infirmary, Huddersfield, UK
| | - Mohamed Abdelmonem
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
| | - Gabriel Fieraru
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
| | - Paul Guyver
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
| |
Collapse
|
4
|
Sandler AB, Scanaliato JP, Narimissaei D, McDaniel LE, Dunn JC, Parnes N. The transition to outpatient shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2022; 31:e315-e331. [PMID: 35278682 DOI: 10.1016/j.jse.2022.01.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Transitioning shoulder arthroplasty (SA) from an inpatient to outpatient procedure is associated with increased patient satisfaction and potentially decreased costs; however, concerns exist about complications following same-day discharge. We hypothesized that outpatient SA would be associated with low rates of failed discharges, readmissions, and complications, rendering it a safe and effective option for SA. METHODS A systematic review of the outpatient SA literature identified 16 of 447 studies with level III and IV evidence that met the inclusion criteria with at least 90 days of follow-up. Data on patient demographic characteristics, preoperative and postoperative protocols, surgery characteristics, failed discharges, complications, and readmissions were collected and pooled for analysis. RESULTS A total of 990 patients were included in our analysis. Many studies identified specific institutional protocols for determining eligibility for outpatient SA, including preoperative clearance from an anesthesiologist; identification of a perioperative caretaker; and exclusion of patients based on cardiac, pulmonary, or hematologic risk factors. Failed same-day discharge occurred in only 0.9% of patients (7 of 788), and 2.1% of patients (9 of 418) and 0.79% of patients (2 of 252) presented to an emergency department or urgent care facility for a perioperative concern. The readmission rate for periprosthetic fracture, arthrofibrosis, infection, subscapularis rupture, and anterior subluxation was 1.3% (7 of 529 patients). Complications occurred in 7.0% of patients (70 of 990), with 5.4% of patients (53 of 990) experiencing a surgical complication and 1.7% (17 of 990) having a medical complication. There were 28 total reoperations (2.9%, 28 of 955 patients). DISCUSSION AND CONCLUSION Outpatient SA is associated with low rates of failed discharges, readmissions, and complications. Additionally, the medical and surgical complications that occur after outpatient SA are unlikely to be prevented by the short inpatient stay characteristic of traditional SA. With careful screening measures to identify appropriate candidates for same-day discharge, outpatient SA represents a safe approach to prevent unnecessary hospitalizations and to decrease costs associated with SA.
Collapse
Affiliation(s)
- Alexis B Sandler
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
| | - John P Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Danielle Narimissaei
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Lea E McDaniel
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, NY, USA; Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, NY, USA
| |
Collapse
|
5
|
Allahabadi S, Cheung EC, Hodax JD, Feeley BT, Ma CB, Lansdown DA. Outpatient Shoulder Arthroplasty-A Systematic Review. J Shoulder Elb Arthroplast 2022; 5:24715492211028025. [PMID: 34993380 PMCID: PMC8492032 DOI: 10.1177/24715492211028025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Recent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose was to review the literature reporting on outpatient SA. Methods A systematic review of publications on outpatient SA was performed. Included publications discussed patients who were discharged on the same calendar day or within 23 hours from surgery. Articles were categorized by discussions on complications, readmissions, and safety, patient selection, pain management strategies, cost effectiveness, and patient and surgeon satisfaction. Results Twenty-six articles were included. Patients undergoing outpatient SA were younger and with a lower BMI than those undergoing inpatient SA. Larger database studies reported more medical complications for patients undergoing inpatient compared to outpatient SA. Articles on pain management strategies discussed both single shot and continuous interscalene blocks with similar outcomes. Both patients and surgeons reported high levels of satisfaction following outpatient SA, and cost analysis studies demonstrated significant cost savings for outpatient SA. Conclusion In appropriately selected patients, outpatient SA can be a safe, cost-saving alternative to inpatient care and may lead to high satisfaction of both patients and physicians, though further studies are needed to clarify appropriate utilization of outpatient SA.
Collapse
Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Edward C Cheung
- Department of Orthopaedic Surgery, University of California, Los Angeles, California
| | - Jonathan D Hodax
- Department of Orthopaedic Surgery, Virginia Mason Medical Center, Virginia Mason Medical Center, Seattle, Washington
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Chunbong B Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| |
Collapse
|
6
|
Kucharik MP, Varady NH, Best MJ, Rudisill SS, Naessig SA, Eberlin CT, Martin SD. Comparison of outpatient vs. inpatient anatomic total shoulder arthroplasty: a propensity score–matched analysis of 20,035 procedures. JSES Int 2021; 6:15-20. [PMID: 35141670 PMCID: PMC8811397 DOI: 10.1016/j.jseint.2021.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background As the proportion of anatomic total shoulder arthroplasty (aTSA) operations performed at outpatient surgical sites continues to increase, it is important to evaluate the clinical implications of this evolution in care. Methods Patients who underwent TSA for glenohumeral osteoarthritis from 2007 to 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Demographic data and 30-day outcomes were collected, and patients were separated into inpatient and outpatient (defined as same day discharge) groups. To control for confounding variables, a propensity score–matching algorithm was utilized. Outcomes included 30-day adverse events, readmission, and operative time. Results A total of 20,035 patients who underwent aTSA between 2007 and 2019 were identified: 18,707 inpatient aTSAs and 1328 outpatient aTSAs. On matching, there were no significant differences in patient characteristics between inpatient and outpatient cohorts. Patients who underwent outpatient aTSA were less likely to experience a serious adverse event when compared with their matched inpatient aTSA counterparts (outpatient: 1.1% vs. inpatient: 2.1%, P = .03). Outpatient aTSA was associated with similar rates of all specific individual complications and readmissions (1.5% vs. 1.9%, P = .31). Conclusion When compared with a propensity score–matched cohort of inpatient counterparts, the present study found outpatient aTSA was associated with significantly reduced severe adverse events and similar readmission rates. These findings support the growing use of outpatient aTSA in appropriately selected patients.
Collapse
Affiliation(s)
- Michael P. Kucharik
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
- Corresponding author: Michael P. Kucharik, BS, BS Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA 02114, USA.
| | - Nathan H. Varady
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Matthew J. Best
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
| | | | - Sara A. Naessig
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
| | - Christopher T. Eberlin
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
| | - Scott D. Martin
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
| |
Collapse
|
7
|
Thangarajah T. Day case shoulder arthroplasty: needed now more than ever. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34431350 DOI: 10.12968/hmed.2021.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The demand for total shoulder arthroplasty has grown over the years and is set to continue in a similar trend because of the ageing population. Following a global reduction in elective orthopaedic treatment and an exponential rise in surgical waiting times, innovative strategies are desperately needed to mitigate against the harmful effects of delaying vital operations on both patients and the wider society. Day case shoulder arthroplasty is a safe alternative to a traditional inpatient approach, with evidence supporting substantial cost savings, improved outcomes and fewer complications. Rigorous patient selection and a multidisciplinary team approach are paramount when adopting a day case service to deliver joint replacement surgery. This review outlines the principles of day case total shoulder arthroplasty and highlights key considerations when transitioning to this approach.
Collapse
Affiliation(s)
- Tanujan Thangarajah
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
8
|
Vajapey SP, Contreras ES, Neviaser AS, Bishop JY, Cvetanovich GL. Outpatient Total Shoulder Arthroplasty: A Systematic Review Evaluating Outcomes and Cost-Effectiveness. JBJS Rev 2021; 9:01874474-202105000-00002. [PMID: 33956691 DOI: 10.2106/jbjs.rvw.20.00189] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Orthopaedic surgical procedures are increasingly being performed in outpatient settings. The drive for cost reduction without compromising patient safety and outcomes has increased interest in outpatient total shoulder arthroplasty (TSA). The primary aim of this study was to perform a review of the evidence regarding the outcomes and cost-effectiveness of outpatient TSA. METHODS A search of the PubMed, Embase, and Cochrane Library databases was performed using several keywords: "outpatient," "shoulder replacement," "ambulatory," "day case," "day-case," "shoulder arthroplasty," "same day," and "shoulder surgery." Studies that were published from May 2010 to May 2020 in the English language were considered. Research design, questions, and outcomes were recorded for each study. Qualitative and quantitative pooled analysis was performed on the data where appropriate. RESULTS Twenty studies met the inclusion criteria. Six retrospective studies compared complication rates between inpatient and outpatient cohorts and found no significant differences. Four studies found that the complication rate was lower in the outpatient cohort compared with the inpatient cohort. In a pooled analysis, the readmission rate after outpatient TSA was significantly lower than the readmission rate after inpatient TSA at 30 days (0.65% vs. 0.95%) and 90 days (2.03% vs. 2.87%) postoperatively (p < 0.05 for both). Four studies evaluated the cost of outpatient TSA in comparison with inpatient TSA. All of these studies found that TSA at an ambulatory surgery center was significantly less costly than TSA at an inpatient facility, both for the health-care system and for the patient. Patient selection for outpatient TSA may depend on several important factors, including the presence or absence of diabetes, chronic obstructive pulmonary disease, chronic kidney disease, congestive heart failure, poor functional status, higher American Society of Anesthesiologists class, chronic narcotic use, higher body mass index, and older age. CONCLUSIONS Our results show that patient selection is the most critical factor that predicts the success of outpatient TSA. While outpatient TSA is significantly less costly than inpatient TSA, patients undergoing outpatient TSA are more likely to be healthier than patients undergoing inpatient TSA. More high-quality long-term studies are needed to add to this body of evidence. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Sravya P Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | | | | |
Collapse
|