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Total ankle replacement yielded cost savings when performed at ASCs
Inpatient facilities were about $4,000 higher in cost per patient compared with the ASC.
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TORONTO —Total ankle replacements performed in an ambulatory surgical center offered more cost-savings benefits than an inpatient facility, according to results presented at the American Orthopaedic Foot and Ankle Surgeons Annual Meeting.
“Performing total ankle replacement in ambulatory surgery centers is cost-effective,” Christopher E. Gross, MD, told Orthopedics Today. “We encourage hospitals to try to emulate the efficiency of ambulatory settings for elective procedures.”
Cost differences
Between 2011 and 2014, Gross and his colleagues identified 574 primary total ankle replacements performed at either an inpatient center or ambulatory surgical center (ASC). Using multivariate analysis and regression modeling to identify cost drivers or explanatory variables, researchers examined the relationships between total cost, operative time and multiple variables, including patient age, gender, comorbidities, types of implant used and concurrent procedures performed.
Gross noted the inpatient facility had higher total costs per patient by about $4,000 compared with the ASC, with inpatient services, pharmacy costs, physical and occupational therapy, laboratory fees, radiology, surgical implant and OR fees identified as significant cost drivers.
“Interestingly, anesthesia costs were higher in the outpatient group, and we were thinking that maybe it is due to the fact that [certified registered nurse anesthesiologists] CRNAs are populating the outpatient group. The anesthesiologist would be the person on-call making sure that people were doing well in the middle of the night at the ASC,” he said in his presentation.
However, researchers found similar post-anesthesia care unit fees in both inpatient facilities and ASCs.
“If all of those patients were to have their total ankle replacement done an in ambulatory surgery setting as opposed to the inpatient setting during that 4-year period, the government would have saved about $1.5 million,” Gross said.
Time efficiency
While the results of the present study were not surprising, Gross said the next step is to see if ASCs are more efficient time-wise compared with inpatient facilities.
“This may show where this is room for improvement and where hospitals can try to imitate the ASCs,” he said.
Gross also plans to follow up on a subsegment of patients sent home the same day after surgery in the present study to see if there were any increased complications, as well as how their surgical costs compared to ASC and hospital patients.
“Hopefully, we can use that data to demonstrate that total ankle replacements can be done in the outpatient setting similar to how total knees have gotten to that point,” Gross said. – by Casey Tingle
- Reference:
- Gross C, et al. Effect of facility on the operative costs of total ankle arthroplasty. Presented at: American Orthopaedic Foot and Ankle Surgeons Annual Meeting; July 21-23, 2016; Toronto.
- For more information:
- Christopher E. Gross, MD, can be reached at the Medical University of South Carolina Health, 169 Ashley Ave., Charleston, SC 29425; email: cgross144@gmail.com.
Disclosure: Gross reports no relevant financial disclosures.