From the Division of Orthopedic Surgery, Department of Surgery, Western University, London, Ont. (Pasic, Akindolire, Ndoja, Del Balso, Lawendy, Lanting, Degen); and the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ont. (Churchill, Degen)
From the Division of Orthopedic Surgery, Department of Surgery, Western University, London, Ont. (Pasic, Akindolire, Ndoja, Del Balso, Lawendy, Lanting, Degen); and the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ont. (Churchill, Degen).
Can J Surg. 2022 Apr 8;65(2):E259-E263. doi: 10.1503/cjs.016420. Print 2022 Mar-Apr.
As health care shifts to value-based models, one strategy within orthopedics has been to transition appropriate cases to outpatient or ambulatory settings to reduce costs; however, there are limited data on the efficacy and safety of this practice for isolated ankle fractures. The purpose of this study was to compare the cost and safety associated with inpatient versus outpatient ankle open reduction internal fixation (ORIF).
All patients who underwent ORIF of isolated closed ankle fractures at 2 affiliated hospitals between April 2016 and March 2017 were identified retrospectively. Demographic characteristics, including age, gender, comorbidities and injuryspecific variables, were collected. We grouped patients based on whether they underwent ankle ORIF as an inpatient or outpatient. We determined case costing for all patients and analyzed it using multivariate regression analysis.
A total of 196 patients (125 inpatient, 71 outpatient) were included for analysis. Inpatients had a significantly longer mean length of stay than outpatients (54.3 h [standard deviation (SD) 36.3 h] v. 7.5 h [SD 1.7 h], < 0.001). The average cost was significantly higher for the inpatient cohort than the outpatient cohort ($4137 [SD $2285] v. $1834 [SD $421], < 0.001). There were more unimalleolar ankle fractures in the outpatient group than in the inpatient group (42 [59.2%] v. 41 [32.8%], < 0.001). Outpatients waited longer for surgery than inpatients (9.6 d [SD 5.6 d] v. 2.0 d [SD 3.3 d], < 0.001). Fourteen patients (11.2%) in the inpatient group presented to the emergency department or were readmitted to hospital within 30 days of discharge, compared to 5 (7.0%) in the outpatient group ( = 0.3).
In the treatment of isolated closed ankle fractures, outpatient surgery was associated with a significant reduction in length of hospital stay and overall case cost compared to inpatient surgery, with no significant difference in readmission or reoperation rates. In medically appropriate patients, isolated ankle ORIF can be performed safely in an ambulatory setting and is associated with significant cost savings.
随着医疗保健向基于价值的模式转变，骨科的一项策略是将合适的病例转移到门诊或日间病房，以降低成本；然而，关于这种治疗孤立性踝关节骨折的疗效和安全性的数据有限。本研究的目的是比较住院与门诊踝关节切开复位内固定（ORIF）的成本和安全性。
回顾性分析 2016 年 4 月至 2017 年 3 月在 2 家附属医院接受单纯闭合性踝关节骨折 ORIF 的所有患者。收集人口统计学特征，包括年龄、性别、合并症和损伤特异性变量。我们根据患者是否接受住院或门诊踝关节 ORIF 进行分组。我们确定了所有患者的病例成本，并使用多元回归分析进行了分析。
共纳入 196 例患者（125 例住院，71 例门诊）进行分析。住院患者的平均住院时间明显长于门诊患者（54.3 小时[标准差（SD）36.3 小时]比 7.5 小时[SD 1.7 小时]，<0.001）。住院患者的平均费用明显高于门诊患者（4137 美元[SD 2285 美元]比 1834 美元[SD 421 美元]，<0.001）。门诊组的单踝骨折多于住院组（42 例[59.2%]比 41 例[32.8%]，<0.001）。门诊患者比住院患者等待手术的时间更长（9.6 天[SD 5.6 天]比 2.0 天[SD 3.3 天]，<0.001）。在出院后 30 天内，住院组有 14 例（11.2%）患者到急诊科就诊或再次入院，而门诊组有 5 例（7.0%）（=0.3）。
在治疗单纯闭合性踝关节骨折时，与住院手术相比，门诊手术可显著缩短住院时间和总病例成本，且再入院或再次手术率无显著差异。在医学上合适的患者中，单纯踝关节 ORIF 可在门诊环境中安全进行，并可显著节省成本。
