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Outpatient management after foot and ankle surgery safe and cost-effective
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LONG BEACH, Calif. — Patients undergoing complex foot and ankle surgery can be safely and more cost-effectively managed postoperatively as an outpatient, according to study findings presented here.
“In patients with complex foot and ankle surgery, outpatient care of ambulatory continuous popliteal catheter results in analgesic and functional outcomes similar to inpatient admission for 48 hours at a significantly reduced cost of care,” Johnny Lau, MD, MSc, FRCSC, said in his presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting.
Lau and colleagues retrospectively compared 20 patients undergoing ankle or hindfoot osteotomy or fusion and complex ligament repairs on an outpatient basis with 20 inpatient controls with the same criteria. Under real-time ultrasound guidance, patients had a perineural sciatic nerve catheter inserted preoperatively before receiving either a general anesthetic or a spinal anesthetic for surgical management. Following surgery, inpatients received patient-controlled analgesia through an electronic pump, whereas outpatients received patient-controlled analgesia through an elastomeric pump for 48 hours to 72 hours. Patients were also prescribed a low dose of oral opioid.
Results showed the inpatient and outpatient groups each had adequate analgesia, and no surgical complications in terms of infection, readmission within 30 days or revision surgery were observed.
Overall, Lau noted the total cost of care was 56% lower in the outpatient group, with the average cost of care for the inpatient group at $7,573 vs. $3,332 for the outpatient group. These costs were a result of the more expensive anesthesia supplies used in the inpatient group, along with the cost of using a recovery room on the day of surgery and the inpatient unit cost, along with fees not normally considered, such as inpatient laboratory, pharmacy, nutritional services and physical costs, Lau said. – by Casey Tingle
Reference:
Lau J, et al. Functional outcome of outpatient vs. inpatient care for complex ankle and hindfoot surgery: A retrospective cohort cost-effectiveness analysis. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; July 15-18, 2015; Long Beach, Calif.
Disclosure: Lau reports no relevant financial disclosures.