Gonzalez Tyler, Fisk Erica, Chiodo Christopher, Smith Jeremy, Bluman Eric M
1 Harvard Combined Orthopaedic Residency Program, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
2 Harvard Medical School, Brigham Foot & Ankle Center, Faulkner Hospital, Boston, MA, USA.
Foot Ankle Int. 2017 May;38(5):507-513. doi: 10.1177/1071100716685551. Epub 2017 Jan 6.
Total ankle arthroplasty (TAA) is a rapidly growing treatment for end-stage ankle arthritis that is generally performed as an inpatient procedure. The feasibility of outpatient total ankle arthroplasty (OTAA) has not been reported in the literature. We sought to establish proof of concept for OTAA by comparing outpatient vs inpatient perioperative complications, postoperative emergency department (ED) visits, readmissions, patient satisfaction, and cost analysis.
From July 2010 to September 2015, a total of 36 patients underwent TAA. Patients with prior ankle replacement, prior ankle infections, neuroarthropathy, or osteonecrosis of the talus were excluded from the study. All patient demographics, tourniquet times, estimated blood loss, comorbidities, concomitant procedures, complications, return ED visits, and readmissions were recorded. Patient satisfaction questionnaires were collected. Twenty-one patients had outpatient surgery and 15 had inpatient surgery. The cohorts were matched demographically.
The average length of stay for the inpatient group was 2.5 days. The overall cost differential between the groups was 13.4%, with the outpatient group being less costly. This correlates to a cost savings of nearly $2500 per case. One patient in the outpatient group had a return ED visit on postoperative day 1 for urinary retention. There were no 30-day readmissions in either group. Seventy-one percent of the outpatient group and 93% of the inpatient group would not change to a different postoperative admission status if they were to have the procedure again.
Our results show that OTAA was a cost-effective and safe alternative with low complication rates and high patient satisfaction. With proper patient selection, OTAA was beneficial to both the patient and the health care system by driving down total cost. It has the capacity to generate substantial savings while providing equal or better value to the patient.
Level III, retrospective comparative study.
全踝关节置换术（TAA）是终末期踝关节炎一种快速发展的治疗方法，通常作为住院手术进行。门诊全踝关节置换术（OTAA）的可行性在文献中尚未见报道。我们试图通过比较门诊与住院患者围手术期并发症、术后急诊就诊、再入院情况、患者满意度及成本分析来确立OTAA的概念验证。
2010年7月至2015年9月，共有36例患者接受了TAA。排除既往有踝关节置换、踝关节感染、神经性关节病或距骨缺血性坏死的患者。记录所有患者的人口统计学资料、止血带使用时间、估计失血量、合并症、同期手术、并发症、返回急诊就诊及再入院情况。收集患者满意度问卷。21例患者接受门诊手术，15例接受住院手术。两组在人口统计学上相匹配。
住院组的平均住院时间为2.5天。两组之间的总体成本差异为13.4%，门诊组成本较低。这相当于每例节省近2500美元。门诊组有1例患者术后第1天因尿潴留返回急诊就诊。两组均无30天内再入院情况。如果再次进行该手术，门诊组71%的患者和住院组93%的患者不会改变术后的入院状态。
我们的结果表明，OTAA是一种具有成本效益且安全的替代方案，并发症发生率低，患者满意度高。通过适当选择患者，OTAA通过降低总成本对患者和医疗保健系统均有益。它有能力在为患者提供同等或更好价值的同时大幅节省费用。
III级，回顾性比较研究。
