Hedrick B, Gettys F K, Richards S, Muchow R D, Jo C-H, Abbott M D
Department of Orthopaedic Surgery, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan, USA.
Department of Pediatric Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.
J Child Orthop. 2018 Jun 1;12(3):273-278. doi: 10.1302/1863-2548.12.170216.
The Ponseti method of treatment is the standard of care for idiopathic clubfoot. Following serial casting, percutaneous tendo-Achilles tenotomy (TAT) is performed to correct residual equinus. This procedure can be performed in either the outpatient clinic or the operating room. The purpose of this study was to evaluate the expense of this procedure by examining hospital charges in both settings.
We retrospectively reviewed charts of 382 idiopathic clubfoot patients with a mean age of 2.4 months (0.6 to 26.6) treated with the Ponseti method at three institutions. Patients were divided into three groups depending on the setting for the TAT procedure: 140 patients in the outpatient clinic (CL), 219 in the operating room with discharge following the procedure (OR) and 23 in the operating room with admission to hospital for observation (OR+). Medical records were reviewed to analyze age, deformity, perioperative complications and specific time spent in each setting. Hospital charges for all three groups were standardized to one institution's charge structure.
Charges among the three groups undergoing TAT (CL, OR, OR+) were found to be significantly different ($3840.60 $7962.30 $9110.00, respectively; p ≤ 0.001), and remained significant when separating unilateral and bilateral deformities (p < 0.001). There were nine total perioperative complications (six returns to the ER and three unexpected admissions to the hospital): five (2.3%) in the OR group, four (17.4%) in the OR+ group and none in the CL group. The OR+ group statistically had a higher rate of complications compared with the other two groups (p = 0.006). The total event time of the CL group was significantly shorter compared with the OR and OR+ groups (129.1, 171.7 and 1571.6 minutes respectively; p < 0.001).
Hospital charges and total event time were significantly less when percutaneous TAT was performed in the outpatient clinic compared with the operating room. In addition, performing the procedure in clinic was associated with the lowest rate of complications.
Therapeutic, Level III.
庞塞蒂治疗方法是治疗特发性马蹄内翻足的标准治疗方案。在进行系列石膏固定后，需行经皮跟腱切断术（TAT）以纠正残留的马蹄足畸形。该手术可在门诊或手术室进行。本研究的目的是通过检查这两种情况下的医院收费情况来评估该手术的费用。
我们回顾性分析了在三家机构接受庞塞蒂方法治疗的382例特发性马蹄内翻足患者的病历，这些患者的平均年龄为2.4个月（0.6至26.6个月）。根据TAT手术的实施地点，患者被分为三组：140例在门诊进行手术（CL组），219例在手术室手术后出院（OR组），23例在手术室手术后住院观察（OR +组）。查阅病历以分析年龄、畸形情况、围手术期并发症以及在每种情况下所花费的具体时间。将三组的医院收费按照一个机构的收费结构进行标准化。
发现接受TAT手术的三组（CL组、OR组、OR +组）收费存在显著差异（分别为3840.60美元、7962.30美元、9110.00美元；p≤0.001），在区分单侧和双侧畸形时差异仍然显著（p < 0.001）。围手术期共有9例并发症（6例返回急诊室，3例意外住院）：OR组5例（2.3%），OR +组4例（17.4%），CL组无并发症。与其他两组相比，OR +组的并发症发生率在统计学上更高（p = 0.006）。CL组的总事件时间与OR组和OR +组相比显著更短（分别为129.1分钟、171.7分钟和1571.6分钟；p < 0.001）。
与手术室相比，在门诊进行经皮TAT手术时，医院收费和总事件时间显著更低。此外，在门诊进行该手术的并发症发生率最低。
治疗性，III级。
