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Beagles CB, Watkins IT, Lechtig A, Blazar P, Chen NC, Lans J. Trends in inpatient versus outpatient upper extremity fracture surgery from 2008 to 2021 and their implications for equitable access: a retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04106-2. [PMID: 39302447 DOI: 10.1007/s00590-024-04106-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE The aim of this study is to describe trends in inpatient and outpatient upper extremity fracture surgery between 2008 and 2021, along with identifying patient factors (age, sex, race, socioeconomic status) associated with outpatient surgery. METHODS Retrospectively, 12,593 adult patients who underwent upper extremity fracture repair from 2008 to 2021 at one of five urban hospitals in the Northeastern USA were identified. Using Distressed Communities Index (DCI), patients were divided into five quintiles based on their level of socioeconomic distress. Multivariable logistic regression was performed on patients from 2008 to 2019 to identify independent factors associated with outpatient management. RESULTS From 2008 to 2019, outpatient procedures saw an average increase of 31%. The largest increases in the outpatient management were seen in humerus (132%) and forearm fractures (127%). Carpal and hand surgeries had the lowest percent increase of 8.1%. Clavicle and wrist fractures were independently associated with outpatient management. Older age, male sex, higher Elixhauser comorbidity index, DCI scores in the 4th or 5th quintile, and fractures of the scapula, humerus, elbow, and forearm were associated with inpatient management. During the onset of the COVID-19 pandemic, there was a decrease in outpatient procedures. CONCLUSION There is a shift toward outpatient surgical management of upper extremity fractures from 2008 to 2021. Application of our findings can serve as an institutional guide to allocate patients to appropriate surgical settings. Moreover, physicians and institutions should be aware of the potential socioeconomic disparities and implement plans to allow for equal access to care.
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Affiliation(s)
- Clay B Beagles
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ian T Watkins
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aron Lechtig
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal C Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Lans
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Buchanan S, Luo E, Bagheri K, Wu KA, Anastasio AT, Kaplan S, Adams S. Racial Disparities in Outcomes After Foot and Ankle Surgery: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2024:S1067-2516(24)00146-7. [PMID: 39009279 DOI: 10.1053/j.jfas.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/27/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
This systematic review and meta-analysis delved into the impact of race and ethnicity on outcomes following foot and ankle surgery, an area garnering increasing attention within the medical community. Despite significant literature on postsurgical clinical and functional outcomes, limited research has explored the influence of racial and ethnic factors on postoperative outcomes. In this study, data from 33 relevant studies, involving a total of 557,734 patients, were analyzed to assess outcomes across different racial and ethnic groups. Notably, only 6 studies met the criteria for inclusion in the final meta-analysis due to variations in outcome reporting. Findings revealed disparities in functional scores, pain levels, and resource utilization among different racial and ethnic cohorts. Specifically, non-White and minority patients exhibited higher rates of foot and ankle fractures and lower extremity surgeries, worse functional outcomes, increased pain, longer hospital stays, and a greater incidence of complications compared to their White counterparts. However, some studies presented contradictory results, emphasizing the necessity for further investigation to elucidate these discrepancies fully. This research underscores the importance of considering racial and ethnic factors in foot and ankle surgery outcomes and highlights the need for targeted interventions to address existing disparities.
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Affiliation(s)
- Scott Buchanan
- Department of Medicine, Campbell University School of Osteopathic Medicine, Lillington, NC
| | - Emily Luo
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Kian Bagheri
- Department of Internal Medicine, HonorHealth Medical Center, Scottsdale, AZ.
| | - Kevin A Wu
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Albert T Anastasio
- Duke University School of Medicine, Department of Orthopaedic Surgery, Durham, NC
| | - Samantha Kaplan
- Department of Medicine, Duke University Medical Center Library, Durham, NC
| | - Samuel Adams
- Duke University School of Medicine, Department of Orthopaedic Surgery, Durham, NC
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3
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Hollawell SM, Yancovitz S, Casciato DJ, Coleman MR. Safety and Outcome Measures of Ankle Open Reduction and Internal Fixation in an Ambulatory Surgical Center. J Foot Ankle Surg 2024; 63:376-379. [PMID: 38266809 DOI: 10.1053/j.jfas.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
The transition of traditionally hospital-based orthopedic procedures to the ambulatory surgery center setting provides many benefits from a patient care and financial perspective. Specifically, closed ankle fractures can potentially be managed at such centers without needing hospitalization. Adding to the paucity of data, this study describes the safety, cost, and outcomes of patients undergoing ankle fracture repair in an ambulatory surgery center. A retrospective chart review of 100 patients who underwent ankle fracture open reduction and internal fixation from a single ambulatory surgery center by 1 surgeon were reviewed. Demographic data, surgical characteristics including operating time and cost were collected. Short- and long-term complications, as well as, reoperation rates were reported and functional outcomes were described. Of the 100 patients, 59% were female and the overall average age was 50 ± 16 years. The average cost per case was $8,709.63 ± 6,360.18. The short-term complication rate was 16%, with surgical site infection reported as the most common complication. No postoperative hospital admissions were reported. Planned and unplanned hardware removal was performed in 7% and 5% of patients, respectively. The delayed union rate was 13%, in which 86% shared a history of smoking. Smoking history was the only statistically significant predictor of prolonged bone healing (p = .002). This investigation demonstrates low complications rates for surgeries performed in a surgery center when compared to historical rates of those procedures performed in the hospital. These results suggest that ambulatory surgery center-based ankle fracture repair does not increase complications while may decrease overall cost when compared to ankle ORIF in a hospital setting.
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Affiliation(s)
- Shane M Hollawell
- Orthopaedic Institute Brielle Orthopedics Foot and Ankle Fellowship, Wall Township, NJ
| | - Sara Yancovitz
- Orthopaedic Institute Brielle Orthopedics Foot and Ankle Fellowship, Wall Township, NJ.
| | | | - Meagan R Coleman
- Orthopaedic Institute Brielle Orthopedics Foot and Ankle Fellowship, Wall Township, NJ
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4
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Bronheim RS, Shu HT, Jami M, Hsu NN, Aiyer AA. Surgical Setting in Achilles Tendon Repair: How Does It Relate to Costs and Complications? FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231205306. [PMID: 37886622 PMCID: PMC10599117 DOI: 10.1177/24730114231205306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Background Primary Achilles tendon repair (ATR) can be performed in ambulatory surgery centers (ASCs) or hospitals. We compared costs and complication rates of ATR performed in these settings. Methods We retrospectively queried the electronic medical record of our academic health system and identified 97 adults who underwent primary ATR from 2015 to 2021. Variables were compared between patients treated at ASCs vs those treated in hospitals. We compared continuous variables with Wilcoxon rank-sum tests and categorical variables with χ2 tests. We used an α of 0.05. Multivariable logistic regression was performed to determine associations between surgical setting and costs. Linear regression was performed between each charge subtype and total cost to identify which charge subtypes were most associated with total cost. Results Patients who underwent ATR in hospitals had a higher rate of unanticipated postoperative hospital admission (13%) than those treated in ASCs (0%) (P = .01). We found no differences with regard to postoperative complications, emergency department visits, readmission, rerupture, reoperation/revision, or death. Patients treated in hospitals had a higher mean (±SD) implant cost ($664 ± $810) than those treated in ASCs ($175 ± $585) (P < .01). We found no differences between settings with regard to total cost, supply costs, operating room charges, or anesthesia charges. Higher implant cost was associated with hospital setting (odds ratio = 16 [95% CI: 1.7-157]) and body mass index > 25 (odds ratio = 1.2 [95% CI: 1.0-1.5]). Operating room costs were strongly correlated with total costs (R2 = .94). Conclusion The overall cost and complication rate of ATRs were not significantly different between ASCs and hospitals. ATRs performed in hospitals had higher implant costs and higher rates of postoperative admission than those performed in ASCs. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Rachel S. Bronheim
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Henry T. Shu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Meghana Jami
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Nigel N. Hsu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Berry A, Houchen-Wolloff L, Crane N, Townshend D, Clayton R, Mangwani J. Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons. World J Orthop 2023; 14:248-259. [PMID: 37155505 PMCID: PMC10122781 DOI: 10.5312/wjo.v14.i4.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case. This could have significant benefits for patients and the health service. However there are theoretical concerns about post-operative complications and patient satisfaction due to pain.
AIM To scope the current practice of foot and ankle surgeons on day-case surgery for major foot and ankle procedures in the United Kingdom (UK).
METHODS An online survey (19 questions) was sent to UK foot and ankle surgeons via the British Orthopaedic Foot & Ankle Society membership list in August 2021. Major foot and ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge, with day surgery as the intended treatment pathway.
RESULTS 132 people responded to the survey invitation with 80% working in Acute NHS Trusts. Currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures. 78% felt that there was scope to perform more procedures as day-case at their centre. Post-operative pain (34%) and patient satisfaction (10%) was not highly measured within their centres. Lack of adequate physiotherapy input pre/post-operatively (23%) and lack of out of hours support (21%) were the top perceived barriers to performing more major foot and ankle procedures as day-case.
CONCLUSION There is consensus among UK surgeons to do more major foot/ankle procedures as day-case. Out of hours support and physiotherapy input pre/ post-op were perceived as the main barriers. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. There is a need for nationally agreed protocols to optimise the delivery of and measurement of outcomes in this type of surgery. At a local level, the provision of physiotherapy and out of hours support should be explored at sites where this is a perceived barrier.
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Affiliation(s)
- Amber Berry
- Department of Physiotherapy, Spire Hospital, Leicester LE2 2FF, United Kingdom
| | - Linzy Houchen-Wolloff
- Department of Physiotherapy, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
| | - Natalie Crane
- Department of Physiotherapy, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
| | - David Townshend
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, North Sheilds NE29 8NH, United Kingdom
| | - Robert Clayton
- Department of Orthopaedics, Victoria Hospital, Kirkcaldy KY2 5AH, United Kingdom
| | - Jitendra Mangwani
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
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6
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Hansen R, Shibuya N, Jupiter DC. An Updated Epidemiology of Foot and Ankle Fractures in the United States: Complications, Mechanisms, and Risk Factors. J Foot Ankle Surg 2022; 61:1034-1038. [PMID: 35181206 DOI: 10.1053/j.jfas.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Foot and ankle fractures are prevalent emergent injuries, about which there remains a lack of in-depth epidemiological information. This analysis of the epidemiology of foot and ankle injuries in the United States updates a previously conducted study. Data from the National Trauma Data Bank (2012-2017) were used for analysis. Demographic variables, mechanism of injuries, and comorbidities were analyzed to determine risk factors for complications after foot and ankle injuries. Young adults aged 21 to 30 years had the highest injury rates; however, in general, older individuals were more at risk for complications. Black individuals were more at risk for certain complications, while Asians were at lower risk, when compared to White individuals. The comorbidities of bleeding disorders, diabetes, smoking, hypertension, and chronic obstructive pulmonary disease all increased risk of at least 1 complication. In terms of mechanism, traffic incidents were found to be the most strongly associated with complications.
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Affiliation(s)
- Regina Hansen
- Graduate School of Biomedical Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Naohiro Shibuya
- Texas A&M University, College of Medicine, Temple, TX; Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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[Translated article] Position statement relating ankle fractures in major outpatient surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Documento de posicionamiento respecto a las fracturas de tobillo en cirugía mayor ambulatoria. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:229-234. [DOI: 10.1016/j.recot.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 10/18/2022] Open
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Meyr AJ, Dougherty M, Kwaadu KY. An Evaluation of Patient Characteristics Associated With Medical Disposition in the Surgical Treatment of Ankle Fractures. J Foot Ankle Surg 2022; 61:72-78. [PMID: 34272159 DOI: 10.1053/j.jfas.2021.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/09/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
The objective of this investigation was to evaluate patient characteristics associated with medical disposition in treatment of ankle fractures. The 2018 American College of Surgeons National Surgical Quality Improvement Program database was interrogated with data extracted related to the 6 current procedural terminology (CPT) codes available pertaining to ankle fractures: 27766, 27769, 27792, 27814, 27822, and 27823. The primary outcome analysis involved a comparison of patient characteristics and short-term adverse outcomes between those fractures repaired on an inpatient basis versus outpatient basis. A secondary analysis was then performed on patient characteristics and adverse short-term outcomes between those fractures treated on an inpatient basis who were discharged home versus elsewhere. Age (p < .001), race (p < .001), ethnicity (p < .001), body mass index (BMI) (p < .001), estimated probability of mortality (p < .001), estimated probability of morbidity (p < .001), CPT code of fracture designation (p < .001), functional status (p < .001), elective surgery designation (p < .001), American Society of Anesthesiologists class (p < .001), diabetes (p < .001), smoking status (p < .001), dyspnea (p < .001), COPD (p < .001), congestive heart failure (p < .001), hypertension (p < .001), dialysis (p < .001), cancer (p < .001), steroid use (p < .001), blood transfusion history (p < .001), and sepsis/systemic inflammatory response syndrome history (p < .001) were all independently associated with the ankle fracture repair being performed on an inpatient basis on regression analysis. Age (p < .001), race (p = .025), ethnicity (p < .001), BMI (p = .001), CPT code of fracture designation (p < .001), preoperative functional status (p < .001), and American Society of Anesthesiologists class (p < .001) were all independently associated with inpatient ankle fracture repairs being discharged to home following the procedure on regression analysis. The results of this investigation demonstrate that differences in patient demographic characteristics might contribute to medical decision-making as it relates to patient management and discharge disposition in the treatment of ankle fractures.
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Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew Dougherty
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
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10
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Kucharik MP, Varady NH, Best MJ, Rudisill SS, Naessig SA, Eberlin CT, Martin SD. Comparison of outpatient vs. inpatient anatomic total shoulder arthroplasty: a propensity score–matched analysis of 20,035 procedures. JSES Int 2021; 6:15-20. [PMID: 35141670 PMCID: PMC8811397 DOI: 10.1016/j.jseint.2021.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background As the proportion of anatomic total shoulder arthroplasty (aTSA) operations performed at outpatient surgical sites continues to increase, it is important to evaluate the clinical implications of this evolution in care. Methods Patients who underwent TSA for glenohumeral osteoarthritis from 2007 to 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Demographic data and 30-day outcomes were collected, and patients were separated into inpatient and outpatient (defined as same day discharge) groups. To control for confounding variables, a propensity score–matching algorithm was utilized. Outcomes included 30-day adverse events, readmission, and operative time. Results A total of 20,035 patients who underwent aTSA between 2007 and 2019 were identified: 18,707 inpatient aTSAs and 1328 outpatient aTSAs. On matching, there were no significant differences in patient characteristics between inpatient and outpatient cohorts. Patients who underwent outpatient aTSA were less likely to experience a serious adverse event when compared with their matched inpatient aTSA counterparts (outpatient: 1.1% vs. inpatient: 2.1%, P = .03). Outpatient aTSA was associated with similar rates of all specific individual complications and readmissions (1.5% vs. 1.9%, P = .31). Conclusion When compared with a propensity score–matched cohort of inpatient counterparts, the present study found outpatient aTSA was associated with significantly reduced severe adverse events and similar readmission rates. These findings support the growing use of outpatient aTSA in appropriately selected patients.
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Affiliation(s)
- Michael P. Kucharik
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
- Corresponding author: Michael P. Kucharik, BS, BS Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA 02114, USA.
| | - Nathan H. Varady
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Matthew J. Best
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
| | | | - Sara A. Naessig
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
| | - Christopher T. Eberlin
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
| | - Scott D. Martin
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, MA, USA
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Unplanned Emergency and Urgent Care Visits After Outpatient Orthopaedic Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202109000-00012. [PMID: 34543235 PMCID: PMC8454905 DOI: 10.5435/jaaosglobal-d-21-00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
Introduction This study sought to determine (1) incident risk, (2) chief report, (3) risk factors, and (4) total cost of unplanned healthcare visits to an emergency and/or urgent care (ED/UC) facility within 30 days of an outpatient orthopaedic procedure. Methods This was a retrospective database review of 5,550 outpatient surgical encounters from a large metropolitan healthcare system between 2012 and 2016. Statistical analysis consisted of measuring the ED/UC incident risk, respective to the procedures and anatomical region. Patient-specific risk factors were evaluated through multigroup comparative statistics. Results Of the 5,550 study patients, 297 (5.4%) presented to an ED/UC within 30 days of their index procedure, with 23 (0.4%) needing to be readmitted. Native English speakers, patients older than 45 years, and nonsmokers had significant reduced relative risk of unplanned ED or UC visit within 30 days of index procedure (P < 0.01). In addition, hand tendon repair/graft had the greatest risk incidence for ED/UC visit (11.0%). Unplanned ED/UC reimbursements totaled $146,357.34, averaging $575.65 per visit. Discussion This study provides an evaluation of outpatient orthopaedic procedures and their relationship to ED/UC visits. Specifically, this study identifies patient-related and procedural-related attributes that associate with an increased risk for unplanned healthcare utilization.
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12
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[Potential of inpatient cases of a university hospital for orthopedics and trauma surgery for outpatient care]. Unfallchirurg 2021; 125:723-730. [PMID: 34463795 PMCID: PMC8406652 DOI: 10.1007/s00113-021-01072-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND The act of the Medical Service of the Health Funds (MDK) is intended to shift health services previously provided in inpatient care to the outpatient care sector in accordance with § 115b SGB V. The aim of this study was the investigation of potential groups of inpatient cases of a university hospital for trauma surgery and orthopedics, which might be at risk for transfer to surgical outpatient treatment. METHODS Data collection using SAP Data Warehouse included all inpatient cases 2017-2019, with subgroup analysis of economic parameters of three risk groups (RG): 1) primary misallocation, 2) procedures of AOP categories 1 and/or 2 and 3) elective 1‑day cases. Furthermore, an analysis of epidemiological parameters and an economic evaluation were performed. RESULTS Primary misallocations related to 245 cases, RG 2 had 764 cases and RG 3 had 891 cases. The average age was 45.5 ± 17.7 years and in 90% there were no relevant comorbidities (PCCL 0). The majority of cases were assigned to DRG I23B and I21Z (removal of osteosynthesis material, 15-23%), followed by open or arthroscopic surgery of the extremities (DRG I32F, I32G, I24Z, I18B, 6-9%). In cases of a statutory shift of inpatient to outpatient surgical procedures, the potential loss of revenue in 2017 was € 1,049,207, in 2018 € 1,076,727 and in 2019 € 923,163. CONCLUSION Individual groups have an increased potential in certain DRGs for a shift from inpatient to outpatient surgical procedures and are at risk for relevant revenue reductions in the course of further expansion of outpatient care. Proactive patient management in terms of outpatient versus inpatient treatment and special management of staff and spatial resources are necessary to anticipate potential downstream revenue cuts.
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13
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Shields CN, Solasz S, Gonzalez LJ, Tong Y, Konda SR, Egol KA. Outpatient lower extremity fracture surgery: should we be concerned? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:719-723. [PMID: 34101006 DOI: 10.1007/s00590-021-03029-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE With rising healthcare costs and insurance push against non-emergent hospital admission, lower extremity fracture treatment is shifting toward outpatient procedures over inpatient hospitalizations. This study compares outcomes for fractures treated as inpatient versus outpatient. METHODS We conducted a retrospective review of lower extremity fracture patients. We collected demographics, injury information, hospital course, and complication data. Length of stay was categorized as "inpatient" and "outpatient" based a 24-h hospital stay cutoff. Data analysis included differences between cohorts with regards to readmissions and complications. RESULTS We identified 229 patients who met inclusion criteria. Inpatient versus outpatient status was predictive of in-hospital complications; however, inpatient versus outpatient status did not predict 1-year readmission. CONCLUSION Outpatient surgery is safe and effective. As the population increases and ages, low-risk surgeries should be considered for outpatient rather than inpatient stays to lower costs, save resources, and reduce complications.
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Affiliation(s)
- Charlotte N Shields
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Sara Solasz
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Leah J Gonzalez
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Yixuan Tong
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | | | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA. .,Jamaica Hospital Medical Center, Queens, NY, USA.
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14
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Gray MT, Hidden KA, Malik AT, Khan SN, Phieffer L, Ly TV, Quatman CE. Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures. Geriatr Orthop Surg Rehabil 2021; 12:21514593211011462. [PMID: 34017613 PMCID: PMC8114236 DOI: 10.1177/21514593211011462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years). Materials and Methods: The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80). Multi-variate regression analyzes were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for baseline clinical characteristics and co-morbidity burdens. Results: A total of 19,585 patients were included: 5.3% were >80 years, 18.1% were 65-79 years, and 76.6% were <65 years. When compared to the non-geriatric population, individuals >80 years were at a significantly Abstract: higher risk of 30-day wound complications (OR 1.84; p = 0.019), pulmonary complications (OR 3.88; p < 0.001), renal complications (OR 1.96; p = 0.015), septic complications (OR 3.72; p = 0.002), urinary tract infections (OR 2.24; p < 0.001), bleeding requiring transfusion (OR 1.90; p = 0.025), mortality (or 7.44; p < 0.001), readmissions (OR 1.65; p = 0.004) and non-home discharge (OR 13.91; p < 0.001). Discussion: Octogenarians undergoing ankle fracture fixation are a high-risk population in need of significant pre-operative surgical and medical optimization. With the majority of patients undergoing non-elective ORIF procedures, it is critical to anticipate potential complications and incorporate experienced geriatric providers early in the surgical management of these patients. Conclusions: Octogenarians and nonagenarians are fundamentally distinct and vulnerable age groups with a high risk of complications, readmissions, mortality and non-home discharges compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Pre-operative counseling and risk-stratification are essential in this vulnerable patient population.
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Affiliation(s)
- Mitchell T Gray
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Krystin A Hidden
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Azeem T Malik
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Safdar N Khan
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura Phieffer
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thuan V Ly
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carmen E Quatman
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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