Meta Fabien, Clark Sean C, Gomez-Ruiz Karen, Trousdale Robert T, Sierra Rafael J, Grigoriou Emmanouil, Hevesi Mario
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Orthop J Sports Med. 2025 May 29;13(5):23259671251341913. doi: 10.1177/23259671251341913. eCollection 2025 May.
Periacetabular osteotomy (PAO) is a complex procedure historically requiring inpatient stay. However, there is increased emphasis for other complex orthopaedic procedures (eg, arthroplasty) to be performed on an outpatient basis by insurance companies. Increasing resistance to insurance approval of inpatient listing for PAO patients at the participating institution suggests that this changing tide is affecting PAO surgery.
To (1) investigate the proportion of PAOs various surgical listing classifications (outpatient, outpatient-overnight, inpatient, etc), (2) determine the incidence of subsequent denial/request for additional documentation for approval of inpatient stay after PAO, and (3) characterize the accuracy of preoperative patient listing classification as well as mean length of stay (LOS) and incidence of successful same-day discharge after PAO at a single institution.
Case series; Level of evidence, 3.
A retrospective chart review was performed to identify all PAOs, performed by 4 participating surgeons, at a single academic institution over a 2-year period. The initial listing status as an outpatient-overnight or inpatient procedure was identified. Whether a preoperative peer review was required for approval of inpatient listings as well as if additional documentation was necessary to convert outpatient-overnight listings to inpatient stays were also recorded.
A total of 140 PAOs among 117 patients were performed with 25 (17.9%) initially listed as an inpatient stay and 115 (82.1%) listed as outpatient-overnight. Of the 25 PAOs listed as inpatient, 2 (8.0%) required a preoperative peer review process to justify or clarify listing status. The mean LOS was 1.9 ± 1.4 days with 55.7% (78/140) of PAOs staying ≥2 nights in the hospital. Only 6 PAOs (4.3%) went home the same day as surgery. Patients who underwent PAO with concomitant hip arthroscopy stayed on average 2.4 ± 1.2 days in comparison with 1.6 ± 1.4 days for those who underwent PAO alone ( < .001). Of the 115 PAOs listed as an outpatient-overnight, 53 (46.1%) converted to an inpatient stay, all of which required service documentation to support conversion to inpatient status.
Over half of PAOs performed resulted in an inpatient stay with patients spending ≥2 nights in the hospital. Additionally, all conversions from outpatient-overnight to inpatient required additional service documentation to support status conversion. Understanding trends in postoperative hospitalizations and LOS may allow for better informed partnerships between surgeons and insurance companies creating more efficient preauthorizations, billing practices, and expected patterns of patient care and discharge.
髋臼周围截骨术（PAO）是一种复杂的手术，历来需要住院治疗。然而，保险公司越来越强调其他复杂的骨科手术（如关节置换术）应在门诊进行。在参与该研究的机构中，PAO患者住院申请越来越难以获得保险公司批准，这表明这种变化的趋势正在影响PAO手术。
（1）调查PAO各种手术清单分类（门诊、门诊过夜、住院等）的比例，（2）确定PAO后住院申请被拒绝/要求补充文件以获得批准的发生率，（3）在单一机构中描述术前患者清单分类的准确性以及PAO后的平均住院时间（LOS）和当日成功出院的发生率。
病例系列；证据等级，3级。
进行回顾性病历审查，以确定在2年期间由4位参与手术的外科医生在单一学术机构进行的所有PAO手术。确定最初作为门诊过夜或住院手术的清单状态。还记录了住院清单批准是否需要术前同行评审，以及将门诊过夜清单转换为住院治疗是否需要补充文件。
117例患者共进行了140例PAO手术，其中25例（17.9%）最初列为住院治疗，115例（82.1%）列为门诊过夜治疗。在列为住院治疗的25例PAO手术中，2例（8.0%）需要术前同行评审来证明或澄清清单状态。平均住院时间为1.9±1.4天，55.7%（78/140）的PAO手术患者住院≥2晚。只有6例PAO手术（4.3%）在手术当天出院。同时进行髋关节镜检查的PAO患者平均住院2.4±1.2天，而单纯进行PAO手术的患者平均住院1.6±1.4天（P<0.001）。在列为门诊过夜治疗的115例PAO手术中，53例（46.1%）转换为住院治疗，所有这些都需要服务文件来支持转换为住院状态。
超过一半的PAO手术患者需要住院治疗，且住院≥2晚。此外，从门诊过夜到住院的所有转换都需要额外补充服务文件以支持状态转换。了解术后住院和住院时间的趋势可能有助于外科医生与保险公司建立更明智的合作关系，从而实现更高效的预授权、计费实践以及预期的患者护理和出院模式。
