Dataset Information

Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study.

ABSTRACT:

Background

The current healthcare market coupled with expedited recovery and improvements in analgesia have led to the development of total hip arthroplasty being performed as an outpatient procedure in selected patients.

Questions/purposes

The purpose of this study is to compare outcomes and cost-effectiveness of traditional inpatient THA with outpatient hip replacement at the same facility.

Patients and methods

This observational, case-control study was conducted from 2008 to 2011. One hundred nineteen patients underwent outpatient THA through a direct anterior approach. These cases were all performed by a single surgeon. Outpatient cases were then compared to inpatient hospital controls performed by the same surgeon at the inpatient hospital facility.

Results

Complications, length of stay, demographic data, and overall costs were compared between groups. There was no difference in complications or estimated blood loss between groups. Most notably, the average overall cost in the outpatient setting was significantly lower than inpatient, $24,529 versus $31,327 (p?=?0.0001).

Conclusions

This study demonstrates that appropriately selected patients can undergo THA in an outpatient setting with no increase in complications and at a substantial savings to the healthcare system.

SUBMITTER: Aynardi M

PROVIDER: S-EPMC4171452 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Publications

Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study.

Aynardi Michael M Post Zachary Z Ong Alvin A Orozco Fabio F Sukin Dean C DC

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20140712 3

<h4>Background</h4>The current healthcare market coupled with expedited recovery and improvements in analgesia have led to the development of total hip arthroplasty being performed as an outpatient procedure in selected patients.<h4>Questions/purposes</h4>The purpose of this study is to compare outcomes and cost-effectiveness of traditional inpatient THA with outpatient hip replacement at the same facility.<h4>Patients and methods</h4>This observational, case-control study was conducted from 200 ...[more]

PMID: 25264442

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Project description:BackgroundA significant proportion of the overall cost of total hip arthroplasty (THA) results from the inpatient hospital stay following the procedure. Considering the substantial and increasing number of these procedures performed annually, shifting to an outpatient model of care where the patient is discharged home the same day as their surgery represents a potential for significant cost savings. The potential significant impact of an outpatient care model on constrained healthcare budgets and lack of high-quality evidence regarding its effectiveness warrants a rigorous comparative trial. The purpose of this prospective, randomized controlled trial is to evaluate outpatient care pathways for THA. Specifically, our objectives are to compare the rate of serious adverse events and estimate the cost-effectiveness of outpatient compared to standard inpatient THA.MethodsWe will include patients undergoing primary THA whom have an American Society of Anaesthetists status equal to or less than three, live within a 60-min driving distance of the institution and have an adult to accompany them home postoperatively and stay with them overnight. Consenting patients will be randomized to be discharged on the same day as surgery, as outpatients, or as inpatients according to standard of care (minimum of one night in hospital) using a modified Zelen consent model. The primary outcome measure is the incidence of serious adverse events at 30 days postoperative. Participants and their caregivers will complete secondary outcomes measures at each follow-up visit including patient-reported outcome measures and self-reported cost questionnaires.DiscussionThis protocol is the first randomized trial to use blinding to evaluate outpatient THA compared to standard overnight stay and first to prospectively perform a full economic evaluation. It is also the first adequately powered trial to prospectively assess the safety of outpatient THA. Successful completion of this study could have the potential to provide clinical evidence for the role of outpatient THA in current practice.Trial registrationThis study was retrospectively registered on ClinicalTrials.gov ( NCT03026764 ) on March 9th, 2016.

Project description:ImportanceThe Hospital Readmissions Reduction Program (HRRP) was recently expanded to penalize excessive readmissions after total hip arthroplasty (THA) and total knee arthroplasty (TKA). These are the first surgical procedures to be included in the HRRP.ObjectiveTo determine whether the HRRP was associated with a greater decrease in readmissions after targeted procedures (THA and TKA) compared with similar nontargeted procedures (lumbar spine fusion and laminectomy).Design, setting, and participantsA retrospective cohort study was conducted of patients 50 years or older among all payers in the Nationwide Readmissions Database who underwent THA, TKA, lumbar spine fusion, or laminectomy between January 1, 2010, and September 30, 2015. Multivariable logistic regression and interrupted time-series models were used to calculate and compare 30-day readmission trends in 3 periods associated with the HRRP: preimplementation (January 2010-September 2012), implementation (October 2012-September 2014), and penalty (October 2014-September 2015). Statistical analysis was performed from January 1, 2010, to September 30, 2015.ExposuresAnnouncement and implementation of the HRRP.Main outcomes and measuresReadmission within 30 days after hospitalization for THA, TKA, lumbar spine fusion, or laminectomy surgery.ResultsThe study included 6 687 077 (58.3% women and 41.7% men; mean age, 66.7 years; 95% CI, 66.7-66.8 years) weighted hospitalizations for THA, TKA, lumbar spine fusion, and laminectomy surgery: 4 765 466 hospitalizations for targeted conditions and 1 921 611 for nontargeted conditions. After passage of the Patient Protection and Affordable Care Act, the risk-adjusted rates of readmission after all procedures decreased in a similar fashion. Implementation of the HRRP was associated with a 0.018% per month decrease in the rate of readmission (95% CI, -0.025% to -0.010%) after targeted procedures, which was not observed after nontargeted procedures (slope per month, -0.003%; 95% CI, -0.016% to 0.010%). Penalties were not associated with a greater decrease in readmission for either targeted or nontargeted procedures.Conclusions and relevanceThese results appear to be consistent with hospitals responding to the future possibility of penalties by reducing readmissions after surgical procedures targeted by the HRRP.

Dataset Information

Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study.

Background

Questions/purposes

Patients and methods

Results

Conclusions

Publications

Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study.

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