Richter Dustin L, Diduch David R
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Orthop J Sports Med. 2017 Mar 14;5(3):2325967117694352. doi: 10.1177/2325967117694352. eCollection 2017 Mar.
Outpatient unicompartmental knee arthroplasty (UKA) has been shown to be safe and feasible when compared with inpatient surgery; however, no studies have evaluated the cost-effectiveness and cost-benefit of performing outpatient versus inpatient UKA.
Significant cost savings can be achieved by transitioning UKAs from an inpatient to an outpatient procedure in an outpatient surgical facility, with no appreciable difference in complication or readmission rates.
Economic and decision analysis; Level of evidence, 3.
A retrospective chart review of 25 consecutive medial UKAs was performed. A total of 10 inpatient UKAs with a mean length of stay of 1.6 days (range, 1-4 days) and 12 outpatient UKAs were included in the final analysis. A simple difference in costs incurred, reimbursements, and percentage difference between inpatient and outpatient surgery in an outpatient surgical facility was calculated. Charges were subdivided into surgical facility fees, inpatient room charges, operating room supply fees, and other fees. Secondary outcome measures included reason for greater than 1 day stay for the inpatient UKAs, complications, readmissions, and the type of regional anesthesia utilized.
The outpatient UKA charges were a mean $20,500 less per patient than the inpatient average charge of $46,845. The primary cost savings were attributed to the outpatient surgical facility fee, which averaged $3800 per patient, while the inpatient facility charge was 350% more expensive at $13,200 per patient (approximately $9500 savings). On the inpatient side, the average reimbursement was 55% of charges, or $25,550. For outpatient procedures, the average reimbursement was 47%, or $12,370. There was no difference between the inpatient and outpatient groups in terms of complications or readmissions.
This work demonstrated that significant cost savings of roughly 50% can be achieved with an outpatient UKA protocol done at an outpatient surgical facility. Not only is it feasible and economically attractive to perform outpatient UKA, but it can reduce inpatient bed occupancy and resource allocation for a busy hospital.
与住院手术相比，门诊单髁膝关节置换术（UKA）已被证明是安全可行的；然而，尚无研究评估门诊与住院UKA的成本效益和成本收益。
在门诊手术机构将UKA从住院手术转变为门诊手术可显著节省成本，且并发症或再入院率无明显差异。
经济与决策分析；证据等级，3级。
对连续25例内侧UKA进行回顾性病历审查。最终分析纳入10例平均住院时间为1.6天（范围1 - 4天）的住院UKA和12例门诊UKA。计算了门诊手术机构中住院和门诊手术的费用、报销金额及两者之间的百分比差异。费用细分为手术机构费用、住院病房费用、手术室耗材费用和其他费用。次要结局指标包括住院UKA住院超过1天的原因、并发症、再入院情况以及所采用的区域麻醉类型。
门诊UKA每位患者的费用平均比住院平均费用46,845美元少20,500美元。主要成本节省归因于门诊手术机构费用，每位患者平均为3800美元，而住院机构费用则贵350%，为每位患者13,200美元（节省约9500美元）。在住院方面，平均报销费用为费用的55%，即25,550美元。对于门诊手术，平均报销比例为47%，即12,370美元。住院组和门诊组在并发症或再入院方面无差异。
这项研究表明，在门诊手术机构采用门诊UKA方案可显著节省约50%的成本。进行门诊UKA不仅可行且在经济上具有吸引力，还可减少繁忙医院的住院床位占用和资源分配。
