Department of Orthopaedics, Kings College Hospital London, King's College Hospital NHS foundation Trust, UK.
Department of Orthopaedics, Kings College Hospital London, King's College Hospital NHS foundation Trust, UK.
Surgeon. 2021 Oct;19(5):e95-e102. doi: 10.1016/j.surge.2020.08.004. Epub 2020 Nov 3.
Preoperative home care for suitable patients with ankle fractures is becoming an increasingly common practice. It allows adequate time for reduction of ankle swelling following a decision to undertake operative fixation has been made. We aim to assess the safety, efficiency, cost-effectiveness and differences in clinical & patient outcomes of day surgery unit (DSU) care for ankle fracture treatment in selected patients. Our study combined home therapy treatment with DSU care for suitable ankle fractures.
Prospective cohort study.
Trauma Centre.
Fifty-three patients requiring operative fixation for an ankle fracture were divided into 2 groups. Patients in group 1 entered the home care combined with DSU treatment pathway whilst in group 2 were treated as in patient in the main trauma theatre in our standard pathway.
Comparison of Home Care & Day Case Surgery vs. in patient admission for patients requiring operative ankle fractures fixation.
Prospective data collection was undertaken over a 2-year period, on fracture type, logistical outcomes including time to surgery and total length of stay in the hospital and clinical outcomes including the rate of post-operative complications, incidence of unplanned surgical revisions and objective patient satisfaction. Economic analysis was performed to compare the marginal cost saving per case for group 1 vs. group 2.
There were 21 patients in group 1. They waited for on average 5.8 days at home for their operation and none were admitted pre or post operatively. There were no associated complications and the majority of patients were discharged from follow-up at 6 weeks post-surgery. In-group 2, there were 32 patients. They waited on average 2.4 days for their operation in the hospital and had an average length of stay of 4.9 days. One patient in group 2 suffered from a deep vein thrombosis. The benefit from our chargeable tariff for group 1 patients was £2295 per case while the margin for group 2 patients was £277 per case. The financial benefit to the health care provider was £2018 in favour of home care and DSU treatment, with high service satisfaction and low complication rates.
This study provides focused evidence supporting the use of home care for the management of ankle fractures. The DSU pathway improves the value in healthcare delivery with high patient satisfaction scores when compared to the traditional pathway. Our model demonstrates predictably good clinical outcomes with a financial cost benefit over in-patient admission care model for selected patients.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
对适合的踝关节骨折患者进行术前家庭护理正变得越来越普遍。这样可以在决定进行手术内固定后，有足够的时间来减轻踝关节肿胀。我们旨在评估日间手术单元（DSU）护理对选定患者踝关节骨折治疗的安全性、效率、成本效益以及临床和患者结局的差异。我们的研究将家庭治疗与 DSU 护理相结合，用于治疗适合的踝关节骨折。
前瞻性队列研究。
创伤中心。
53 名需要手术固定踝关节骨折的患者被分为 2 组。第 1 组患者进入家庭护理联合 DSU 治疗途径，而第 2 组患者则按照我们的标准途径在主要创伤手术室接受住院治疗。
比较家庭护理和日间手术与住院患者治疗需要手术固定的踝关节骨折。
在 2 年的时间内进行前瞻性数据收集，记录骨折类型、包括手术时间和总住院时间在内的后勤结果以及包括术后并发症发生率、计划外手术修订发生率和客观患者满意度在内的临床结局。对第 1 组与第 2 组的每例患者边际成本节约进行经济分析。
第 1 组有 21 名患者。他们平均在家等待 5.8 天接受手术，术前和术后均无人住院。没有相关并发症，大多数患者在术后 6 周随访时出院。第 2 组有 32 名患者。他们在医院平均等待 2.4 天接受手术，平均住院时间为 4.9 天。第 2 组有 1 名患者患有深静脉血栓形成。第 1 组患者的收费服务收费为每例 2295 英镑，而第 2 组患者的边际费用为每例 277 英镑。家庭护理和 DSU 治疗对医疗保健提供者具有财务效益，支持率为 2018 英镑，且服务满意度高，并发症发生率低。
本研究为家庭护理管理踝关节骨折提供了重点证据。与传统途径相比，日间手术单元途径通过提高患者满意度评分，改善了医疗保健服务的价值。我们的模型为选定患者展示了可预测的良好临床结局，并具有比住院患者入院护理模型更具成本效益的优势。
治疗性三级。请参阅作者说明以获取完整的证据水平描述。
