From the UMass Chan Medical School, Worcester, MA (Kim), the Department of Surgery, Massachusetts General Hospital, Boston, MA (Kim, Nin, Chen, Chang), the Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA (Talmo, Niu, Mattingly, Smith), and the Department of Infectious Disease, New England Baptist Hospital, Boston, MA (Hollenbeck).
J Am Acad Orthop Surg. 2024 Dec 1;32(23):1095-1100. doi: 10.5435/JAAOS-D-23-00698. Epub 2024 May 7.
As total knee arthroplasty (TKA) further transitions toward an outpatient procedure, it becomes important to identify the resource utilization after TKAs at different outpatient facilities. The objective of this study was to determine the 90-day cost of patients who underwent TKAs at an ambulatory surgical center (ASC) or a hospital outpatient department (HOPD).
An observational cohort study was conducted using the Marketscan database with patients who had a TKA at an ASC or HOPD between January 1st, 2019, and October 2nd, 2021. The primary outcome was cost in a 90-day period (including the day of surgery), with inpatient admissions and ED visits as secondary outcomes. Multivariable regression analyses were conducted, adjusting for patient characteristics.
The study population consisted of 47,261 patients with 7,874 ASC patients and 39,387 HOPD patients. 90-day costs for ASC patients were lower compared with HOPD patients ($35,634 ± 19,030 vs. $38,096 ± 24,389, P < 0.001). 90-day inpatient admission rates were lower for ASC than HOPD patients (2.5% vs. 4.8%, P < 0.001). 90-day ED visits for ASC patients were lesser compared with HOPD patients (8.9% vs. 12.7%, P < 0.001).
Patients with TKAs at an ASC had an overall lower cost, inpatient admissions, and ED visits over a 90-day period compared with HOPD patients. Future consideration for which outpatient facilities patients have their TKA at is necessary as TKAs shift toward bundle payments and outpatient procedures.
随着全膝关节置换术（TKA）进一步向门诊手术转变，确定在不同门诊设施接受 TKA 后的资源利用情况变得非常重要。本研究的目的是确定在门诊手术中心（ASC）或医院门诊部门（HOPD）接受 TKA 的患者在 90 天内的成本。
本研究采用 Marketscan 数据库进行观察性队列研究，纳入 2019 年 1 月 1 日至 2021 年 10 月 2 日期间在 ASC 或 HOPD 接受 TKA 的患者。主要结局是 90 天内（包括手术当天）的成本，以住院入院和急诊就诊为次要结局。采用多变量回归分析，调整患者特征。
研究人群包括 47261 名患者，其中 ASC 患者 7874 名，HOPD 患者 39387 名。与 HOPD 患者相比，ASC 患者的 90 天成本较低（35634±19030 美元比 38096±24389 美元，P<0.001）。ASC 患者的 90 天住院入院率低于 HOPD 患者（2.5%比 4.8%，P<0.001）。ASC 患者的 90 天急诊就诊率低于 HOPD 患者（8.9%比 12.7%，P<0.001）。
与 HOPD 患者相比，在 ASC 接受 TKA 的患者在 90 天内的总成本、住院入院率和急诊就诊率均较低。随着 TKA 向捆绑支付和门诊手术转变，有必要考虑患者在哪些门诊设施接受 TKA。
