University of Toronto.
Department of Anesthesia and Pain Management, Toronto Western Hospital; Department of Anesthesia, University of Toronto.
J Clin Anesth. 2016 Dec;35:20-25. doi: 10.1016/j.jclinane.2016.07.014. Epub 2016 Aug 4.
To compare the postoperative functional outcome and the total cost associated with outpatient vs inpatient care following complex hind-foot and ankle surgery.
Retrospective, cohort study.
Tertiary care center.
Forty patients, American Society of Anesthesiologists 1-3, of either sex undergoing elective complex hind-foot and ankle surgery (fusion, osteotomy, or multiple ligament repair).
Both inpatients and outpatients received a continuous perineural infusion of local anesthetic for 48 hours at the core of a multimodal analgesic regimen. Patients were retrospectively identified, and an outpatient cohort was matched to an inpatient cohort in a 1:1 ratio for age, sex, baseline functional score, and type of surgery.
The primary outcome was functional outcome upon discharge of the surgical program as measured by the Lower Extremity Functional Score. Secondary outcomes were the incidence of surgical or anesthetic complications and the total perioperative cost of care.
Patients in both cohorts had similar functional outcome on discharge of the surgical program. Analgesia was effective in both groups, and no complications were reported. The cost of care for outpatients was 54% lower than that for inpatients.
This retrospective study suggests that outpatient care including an ambulatory perineural infusion of local anesthetic may be a cost-effective alternative to inpatient care after complex foot and ankle surgery.
比较复杂足踝手术后门诊与住院护理的术后功能结果和总费用。
回顾性队列研究。
三级护理中心。
40 名美国麻醉医师协会 1-3 级的患者，性别不限，接受择期复杂足踝手术（融合、截骨或多韧带修复）。
住院和门诊患者均在多模式镇痛方案的核心部位接受 48 小时连续外周神经阻滞局部麻醉。患者被回顾性识别，并根据年龄、性别、基线功能评分和手术类型以 1:1 的比例将门诊队列与住院队列相匹配。
主要结果是手术项目出院时的功能结果，通过下肢功能评分进行测量。次要结果是手术或麻醉并发症的发生率以及围手术期护理的总费用。
两组患者在出院时的功能结果相似。两组的镇痛效果均有效，且无并发症报告。门诊患者的护理费用比住院患者低 54%。
这项回顾性研究表明，包括门诊外周神经阻滞局部麻醉的门诊护理可能是复杂足踝手术后住院护理的一种具有成本效益的替代方案。
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