From the Faculty of Medicine, McGill University, Montréal, Que. (Moisan); and the Division of Orthopaedic Surgery, McGill University, Montréal, Que. (Montreuil, Bernstein, Hart, Tanzer).
From the Faculty of Medicine, McGill University, Montréal, Que. (Moisan); and the Division of Orthopaedic Surgery, McGill University, Montréal, Que. (Montreuil, Bernstein, Hart, Tanzer)
Can J Surg. 2023 Feb 2;66(1):E59-E65. doi: 10.1503/cjs.000722. Print 2023 Jan-Feb.
Although day surgery (DS) total hip arthroplasty (THA) has good patient satisfaction and a good safety profile, accurate episode-of-care cost (EOCC) calculations for this procedure compared to standard same-day admission (SDA) THA are not well known. We determined the EOCCs for patients who underwent THA, comparing DS and SDA pathways.
We evaluated the EOCCs for consecutive patients who underwent DS or SDA THA for osteoarthritis or osteonecrosis performed by a single surgeon at 1 academic centre from July 2018 to January 2020. Patient demographic and clinical data were recorded, as were preoperative diagnosis, type of anesthesia, type of implant used, surgical time and estimated blood loss. We determined direct and indirect costs from time of arrival at the presurgical unit to hospital discharge. We determined the EOCCs using an ABC method.
The study included 50 patients who underwent THA (25 DS, 25 SDA). The mean length of stay in the SDA group was 45.1 (standard deviation [SD] 21.4) hours. Differences were observed between the 2 groups in mean age, mean Charlson Comorbidity Index score, surgical technique and mean surgical time ( ≤ 0.001). The mean total EOCC for SDA THA was $10 911 (SD $706.12, range $9944.07-$12 871.95), compared to $9672 (SD $546.55, range $8838.30-$11 058.07) for DS THA, a difference of 11.4%, mostly attributable to hospital resources such as laboratory tests, radiologic studies and cost of the surgical admission.
Day surgery THA is cost-effective in selected patient populations. With the savings identified in this study, every 10 additional DS THA procedures would save sufficient resources to perform an additional THA operation.
尽管日间手术（DS）全髋关节置换术（THA）具有良好的患者满意度和良好的安全性，但与标准的当日入院（SDA）THA 相比，该手术的准确单次住院费用（EOCC）计算并不为人所知。我们比较了 DS 和 SDA 两种途径，确定了接受 THA 的患者的 EOCC。
我们评估了 2018 年 7 月至 2020 年 1 月期间，在一家学术中心，一位外科医生为骨关节炎或骨坏死患者进行的 DS 或 SDA THA 的连续患者的 EOCC。记录患者的人口统计学和临床数据，包括术前诊断、麻醉类型、使用的植入物类型、手术时间和估计失血量。我们从术前单元到达至出院确定直接和间接成本。我们使用 ABC 法确定 EOCC。
该研究纳入了 50 例接受 THA 的患者（25 例 DS，25 例 SDA）。SDA 组的平均住院时间为 45.1（标准差 [SD] 21.4）小时。两组之间在平均年龄、平均 Charlson 合并症指数评分、手术技术和平均手术时间方面存在差异（≤0.001）。SDA THA 的总 EOCC 平均为 10911 美元（SD 706.12 美元，范围 9944.07-12871.95 美元），而 DS THA 的总 EOCC 平均为 9672 美元（SD 546.55 美元，范围 8838.30-11058.07 美元），差异为 11.4%，主要归因于医院资源，如实验室检查、放射学研究和手术入院费用。
在选定的患者人群中，日间手术 THA 具有成本效益。通过本研究确定的节省，可以进行额外的 10 例 DS THA 手术，以节省足够的资源来进行额外的 THA 手术。
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