From the School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont. (Marsh); the Bone and Joint Institute, Western University, London, Ont. (Marsh, Howard, Lanting); the London Health Sciences Centre, London, Ont. (Somerville, Howard, Lanting); and the Schulich School of Medicine and Dentistry, Western University, London, Ont. (Somerville, Howard, Lanting).
Can J Surg. 2019 Feb 1;62(1):20-24. doi: 10.1503/cjs.002118.
A substantial portion of the cost of total knee arthroplasty (TKA) results from the postoperative inpatient length of stay (LOS). Considering the annual increase in TKAs, reducing LOS represents a potential for cost savings. We sought to compare in-hospital costs and patient-reported outcomes for an early discharge protocol compared with the standard LOS following TKA.
We conducted a retrospective matched cohort study, matching patients on age, sex, body mass index and preoperative Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) score. We compared costs associated with time in the operating room, intraoperative pain control and inpatient stay as well as 1-year postoperative patient-reported outcomes between early discharge and standard LOS groups.
We included 50 patients in our study (25 per group). The average LOS in the early discharge group was 26.5 hours, compared with 48.9 hours in the standard care group. The early discharge group had higher intraoperative costs associated with pain control (mean difference 26.98, 95% confidence interval 14.41-37.90, < 0.01); however, this difference was offset by substantial savings associated with the reduced LOS. The mean total cost for the early discharge group was $649.62 ± $281.71 versus $1279.71 ± $515.98 for the standard care group. There were no significant differences in SF12 or WOMAC scores between groups at 1 year postoperative.
In-hospital costs were significantly lower with a postoperative day 1 discharge protocol than with standard LOS following TKA, with no difference in patient-reported outcomes.
全膝关节置换术（TKA）的总成本中相当一部分来自术后住院住院时间（LOS）。考虑到 TKA 的年增长率，缩短 LOS 代表了节省成本的潜力。我们旨在比较早期出院方案与 TKA 后标准 LOS 的住院成本和患者报告的结果。
我们进行了回顾性匹配队列研究，根据年龄、性别、体重指数和术前西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分匹配患者。我们比较了手术室内时间、术中疼痛控制和住院时间以及 1 年术后患者报告的结果之间的成本，以比较早期出院组和标准 LOS 组之间的成本。
我们的研究包括 50 名患者（每组 25 名）。早期出院组的平均 LOS 为 26.5 小时，而标准护理组为 48.9 小时。早期出院组的术中疼痛控制成本较高（平均差异 26.98，95%置信区间 14.41-37.90， < 0.01）；然而，这种差异被与缩短 LOS 相关的大量节省所抵消。早期出院组的平均总费用为 649.62 ± 281.71 美元，而标准护理组为 1279.71 ± 515.98 美元。两组在术后 1 年的 SF12 或 WOMAC 评分无显著差异。
与 TKA 后标准 LOS 相比，术后第 1 天出院方案的住院成本显著降低，而患者报告的结果无差异。
