Department of Orthopedics, Brown University.
Warren Alpert Medical School of Brown University, Providence, RI.
J Pediatr Orthop. 2022 Jan 1;42(1):4-9. doi: 10.1097/BPO.0000000000001999.
In an effort to increase the value of health care in the United States, there has been increased focus on shifting certain procedures to an outpatient setting. While pediatric supracondylar humerus fractures (SCHFs) have traditionally been treated in an inpatient setting, recent studies have investigated the safety and efficiency of outpatient surgery for these injuries. This retrospective study aims to examine ongoing trends of outpatient surgical care for SCHFs, examine the safety and complication rates of these procedures, and investigate the potential cost-savings from this shift in care.
Pediatric patients less than 13 years old who underwent surgery for closed SCHF from 2009 to 2018 were identified using International Classification of Diseases-9/10 Clinical Modification and Procedural Classification System codes in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Linear regression was used to assess the shift in proportion of outpatient surgical management of these injuries over time. Multivariable Cox proportional hazards regression was used to compare return to emergency department (ED) visit, readmission, reoperation, and other adverse events. A 2-sample t test was performed on the average charge amount per claim for inpatient versus outpatient surgery.
A total of 8488 patients were included in the analysis showing there was a statistically significant shift towards outpatient management between 2009 (23% outpatient) and 2018 (59% outpatient) (P<0.0001). Relative to inpatient surgical management, outpatient surgical management had lower rates of return ED visits at 1 month (hazard ratio: 0.744, P=0.048). All other adverse events compared across inpatient and outpatient surgical management were not significantly different. The median amount billed per claim for inpatient surgeries was significantly higher than for outpatient surgeries ($16,097 vs. $9,752, P<0.0001). White race, female sex, and weekday ED visit were associated with increased rate of outpatient management.
This study demonstrates the trend of increasing outpatient surgical management of pediatric SCHF from 2009 to 2018. The increased rate of outpatient management has not been associated with elevated complication rates but is associated with significantly reduced health care charges.
Level III-retrospective cohort.
为了提高美国医疗保健的价值，人们越来越关注将某些程序转移到门诊环境中。虽然小儿尺骨鹰嘴骨折（SCHF）传统上是在住院环境中治疗的，但最近的研究调查了这些损伤门诊手术的安全性和效率。本回顾性研究旨在检查小儿 SCHF 门诊手术护理的持续趋势，检查这些手术的安全性和并发症发生率，并调查从这种护理转变中节省的潜在成本。
使用纽约州规划和研究合作系统（SPARCS）数据库中的国际疾病分类-9/10 临床修正和程序分类系统代码，在纽约州 SPARCS 数据库中确定 2009 年至 2018 年期间因闭合性 SCHF 接受手术的 13 岁以下小儿患者。线性回归用于评估这些损伤门诊手术管理比例随时间的变化。多变量 Cox 比例风险回归用于比较返回急诊部（ED）就诊、再入院、再次手术和其他不良事件的情况。对住院手术与门诊手术每例索赔的平均费用进行两样本 t 检验。
共纳入 8488 例患者，分析显示，2009 年（23%门诊）与 2018 年（59%门诊）之间，门诊管理的比例有统计学意义的转变（P<0.0001）。与住院手术管理相比，门诊手术管理 1 个月时返回 ED 就诊的比例较低（风险比：0.744，P=0.048）。与住院和门诊手术管理相比，所有其他不良事件均无显著差异。住院手术每例索赔的计费中位数明显高于门诊手术（$16097 与$9752，P<0.0001）。白人种族、女性性别和工作日 ED 就诊与门诊管理率增加有关。
本研究表明，2009 年至 2018 年，小儿 SCHF 的门诊手术管理呈上升趋势。门诊管理率的增加与并发症发生率的升高无关，但与医疗费用的显著降低有关。
III 级-回顾性队列。
