Huang Adrian, Ryu Jae-Jin, Dervin Geoffrey
All authors are from the Division of Orthopaedic Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, Ont.
Can J Surg. 2017 Feb;60(1):57-62. doi: 10.1503/cjs.002516.
With diminishing reimbursement rates and strained public payer budgets, a high-volume inpatient procedure, such as total knee arthroplasty (TKA), is a common target for improving cost efficiencies.
This prospective case-control study compared the cost-minimization of same day discharge (SDD) versus inpatient TKA. We examined if and where cost savings can be realized and the magnitude of savings that can be achieved without compromising quality of care. Outcome variables, including detailed case costs, return to hospital rates and complications, were documented and compared between the first 20 SDD cases and 20 matched inpatient controls.
In every case-control match, the SDD TKA was less costly than the inpatient procedure and yielded a median cost savings of approximately 30%. The savings came primarily from costs associated with the inpatient encounter, such as surgical ward, pharmacy and patient meal costs. At 1 year, there were no major complications and no return to hospital or readmission encounters for either group.
Our results are consistent with previously published data on the cost savings associated with short stay or outpatient TKA. We have gone further by documenting where those savings were in a matched cohort design. Furthermore, we determined where cost savings could be realized during the patient encounter and to what degree. In carefully selected patients, outpatient TKA is a feasible alternative to traditional inpatient TKA and is significantly less costly. Furthermore, it was deemed to be safe in the perioperative period.
随着报销率的降低和公共支付者预算的紧张，诸如全膝关节置换术（TKA）这样的高流量住院手术成为提高成本效益的常见目标。
这项前瞻性病例对照研究比较了同日出院（SDD）与住院TKA的成本最小化情况。我们研究了是否以及在何处可以实现成本节约，以及在不影响护理质量的情况下能够实现的节约幅度。记录并比较了前20例SDD病例和20例匹配的住院对照病例的结果变量，包括详细的病例成本、重返医院率和并发症情况。
在每一对病例对照匹配中，SDD TKA的成本均低于住院手术，中位成本节约约30%。节约主要来自与住院相关的成本，如手术病房、药房和患者餐饮成本。在1年时，两组均无重大并发症，也没有重返医院或再次入院情况。
我们的结果与先前发表的关于与短期住院或门诊TKA相关的成本节约数据一致。我们通过在匹配队列设计中记录节约发生的位置进一步深入研究。此外，我们确定了在患者诊疗过程中可以在何处实现成本节约以及节约的程度。在精心挑选的患者中，门诊TKA是传统住院TKA的可行替代方案，且成本显著更低。此外，它在围手术期被认为是安全的。
