Ode Gabriella E, Odum Susan, Connor Patrick M, Hamid Nady
Department of Orthopaedic Surgery, Prisma Health - Upstate, Greenville, SC, USA.
Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.
JSES Int. 2020 Jan 3;4(1):127-132. doi: 10.1016/j.jses.2019.10.001. eCollection 2020 Mar.
The purpose of this study was to evaluate the clinical outcomes and cost of shoulder arthroplasty (SA) performed in ambulatory surgery centers (ASCs) compared with SA performed in hospital-based surgery settings.
The State Inpatient Databases and the State Ambulatory Surgery Databases were queried for patients undergoing primary or reverse SA between 2010 and 2014 in 5 states in either the inpatient (IP), hospital outpatient department (HOPD), or ASC setting. Outcomes included all-cause readmissions, emergency department visits within the 90-day postoperative period, and charges. Covariates included patient demographic data and procedure details. Risk factors for readmission were calculated using logistic regression analysis.
We identified 795 ASC (2%), 183 HOPD (0.5%), 38,114 (97.5%) SA procedures. The outpatient cohort was overall younger and healthier with a lower percentage of diabetes (14.1% vs. 20.2%), cardiopulmonary disease (11.4% vs. 20.4%), and obesity (10.7% vs. 15.6%). The US state and obesity were factors significantly ( < .0001) associated with readmission. The median IP charge was $62,905 (range, $41,327-$87,881) vs. $37,395 (range, $21,976-$61,775) for combined outpatient cases. When outpatient SA was stratified into ASC and HOPD cases, the median charges were $31,790 for ASC cases vs. $55,990 for HOPD cases ( < .0001). After adjustment for multiple covariates, the charges for combined outpatient SA surgery were 40% lower than those for IP SA surgery ( < .0001).
As the current health care climate shifts toward lower-cost and higher-quality care, this study demonstrates that SAs performed in ASCs have a comparable safety profile to and significant financial advantage over SAs performed in the hospital-based setting.
本研究的目的是评估在门诊手术中心（ASC）进行的肩关节置换术（SA）与在医院手术环境中进行的SA相比的临床结果和成本。
查询2010年至2014年期间5个州在住院（IP）、医院门诊部（HOPD）或ASC环境中接受初次或翻修SA的患者的州住院数据库和州门诊手术数据库。结果包括全因再入院、术后90天内的急诊科就诊次数和费用。协变量包括患者人口统计学数据和手术细节。使用逻辑回归分析计算再入院的危险因素。
我们确定了795例ASC（2%）、183例HOPD（0.5%）、38114例（97.5%）SA手术。门诊队列总体上更年轻、更健康，糖尿病（14.1%对20.2%）、心肺疾病（11.4%对20.4%）和肥胖（10.7%对15.6%）的比例更低。美国州别和肥胖是与再入院显著相关（<0.0001）的因素。IP的中位费用为62905美元（范围41327美元至87881美元），而联合门诊病例为37395美元（范围21976美元至61775美元）。当门诊SA分为ASC和HOPD病例时，ASC病例的中位费用为31790美元，HOPD病例为55990美元（<0.0001）。在对多个协变量进行调整后，联合门诊SA手术的费用比IP SA手术低40%（<0.0001）。
随着当前医疗保健环境向低成本、高质量护理转变，本研究表明，在ASC进行的SA与在医院环境中进行的SA具有相当的安全性，且在经济上具有显著优势。
