Moon Andrew S, McGee Andrew S, Patel Harshadkumar A, Cone Ryan, McGwin Gerald, Naranje Sameer, Shah Ashish
University of Alabama School of Medicine, Birmingham, Alabama (AS Moon, AS McGee, HAP, RC, SN, AS).
Tufts University School of Medicine, Boston, Massachusetts (AS Moon); and Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama (GM).
Foot Ankle Spec. 2019 Aug;12(4):336-344. doi: 10.1177/1938640018803699. Epub 2018 Oct 4.
Hindfoot fusion procedures are increasingly being performed in the outpatient setting. However, the cost savings of these procedures compared with the risks and benefits has not been clearly investigated. The objective of this study was to compare patient characteristics, costs, and short-term complications between inpatient and outpatient procedures. This was a retrospective review of all patients who underwent inpatient and outpatient hindfoot fusion procedures by a single surgeon, at 1 academic institution, from 2013 to 2017. Data collected included demographics, operative variables, comorbidities, complications, costs, and subsequent reencounters. Of 124 procedures, 34 were inpatient and 90 were outpatient. Between procedural settings, with the numbers available, there was no significant increase in complication rate or frequency of reencounters within 90 days. There were no significant differences in the number of patients with reencounters related to the index procedure within 90 days (P = .43). There were 30 reencounters within 90 days after outpatient surgery versus 4 after inpatient surgery (P = .05). The total number of emergency room visits in the outpatient group within 90 days was significantly higher compared with the inpatient group (P = .04). The average cost for outpatient procedures was US$4159 less than inpatient procedures (P < .0001). Outpatient hindfoot fusion may be a safe alternative to inpatient surgery, with significant overall cost savings and similar rate of short-term complications. On the basis of these findings, we believe that outpatient management is preferable for the majority of patients, but further investigation is warranted. Level III.
后足融合手术越来越多地在门诊环境中进行。然而，与这些手术的风险和益处相比，其成本节约情况尚未得到明确研究。本研究的目的是比较住院手术和门诊手术患者的特征、成本及短期并发症。这是一项对2013年至2017年在一家学术机构由单一外科医生进行住院和门诊后足融合手术的所有患者的回顾性研究。收集的数据包括人口统计学资料、手术变量、合并症、并发症、成本及后续再就诊情况。在124例手术中，34例为住院手术，90例为门诊手术。在手术方式之间，就现有数据而言，90天内并发症发生率或再就诊频率没有显著增加。90天内与初次手术相关的再就诊患者数量没有显著差异（P = 0.43）。门诊手术后90天内有30次再就诊，而住院手术后有4次（P = 0.05）。门诊组90天内急诊室就诊总数显著高于住院组（P = 0.04）。门诊手术的平均成本比住院手术低4159美元（P < 0.0001）。门诊后足融合术可能是住院手术的一种安全替代方案，总体成本显著节约，短期并发症发生率相似。基于这些发现，我们认为大多数患者选择门诊治疗更可取，但仍需进一步研究。三级证据。
