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ASC associated with cost-effective pinning of supracondylar humeral fractures
Treatment should be provided in whatever environment is safest and provides the best outcome for the patient.
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Surgical treatment of Gartland type 2 supracondylar humeral fractures in pediatric patients was associated with shorter surgical and total facility time and was less expensive when performed at an ASC compared with the hospital inpatient or outpatient setting, according to results of a study.
Carson M. Rider, MD, of University of Tennessee Health Science Center and Campbell Clinic Orthopedic Surgery Residency Program, and his colleagues stratified 316 pediatric patients with Gartland type 2 supracondylar humeral fractures into a hospital inpatient group (n=231), hospital outpatient group (n=35) or an ASC group (n=50). Researchers collected information about patient demographics, complications, radiographic measurements, surgical time, facility use and total charges. The three groups were similar preoperatively for age, BMI, gender, radiographic parameters and outcomes, healing and complications.
“[Closed reduction and percutaneous pinning] CRPP was 33% faster in the surgery center with shorter surgical times, less anesthesia exposure, as well as less time the child was away from the parent,” Rider said at a meeting.
When ER time was eliminated from the time analysis, the ASC group still had a significantly shorter total facility time, Rider said.
“At our institution, the full-service children’s hospital has a more complex admission process, more complex documentation and care-based protocols, as well as more complex patient flow, in general, which could explain some of these time differences,” Rider said.
The ASC group had charges that were 63% lower and 73% lower, respectively, than for the hospital outpatient and inpatient groups, according to Rider. In an interview with Orthopedics Today, he said with the large number of fractures treated at their institution annually, the differences in cost and time for treatment can quickly accumulate.
“Over our 4.5-year study period, if all the hospital patients had been treated in a surgery center, charge savings would total approximately $3.2 million,” he said in his presentation. “Even if one-third of these hospital inpatients had been treated in the surgery center, the charge savings would total $1 million.”
Because the study was retrospective, Rider said they used charge data instead of true treatment cost, “which may not reflect the exact amount paid by patients and third-party payers.”
Further, indirect costs to families due to increased facility time in both hospital groups could not be calculated and included in the results.
“Studies looking at different fracture types, as well as patient/family satisfaction scores and true direct and indirect costs are necessary and underway,” Rider said. “The treatment of each patient, however, should be based on his or her unique injury with a goal of providing the safest environment for obtaining the best possible outcome, regardless of speed and cost.” – by Casey Tingle
- Reference:
- Rider CM, et al. J Pediatr Orthop. 2018;doi:10.1097/BPO.0000000000001171.
- For more information:
- Carson M. Rider, MD, can be reached at 910 Madison Ave., Memphis, TN0 38163; email: carsonrider@gmail.com.
Disclosure: Rider reports no relevant financial disclosures.
Perspective
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Mauricio Silva, MD
Rider and colleagues compared outcomes (clinical, radiographic, efficiency and cost) of children with Gartland type 2 supracondylar humerus (SCH) fractures managed surgically at a free-standing ASC vs. a children’s hospital (inpatient or outpatient). Among 316 patients in the study, 50 patients (16%) were treated at an ASC. The authors reported no significant differences in radiographic outcomes, healing or complications between the groups. However, for patients treated at an ASC, surgery was 31% to 39% faster, the length of stay was decreased by at least 4 hours and the procedure was 63% to 73% less expensive than treatment in a hospital. Achieving high value for patients (health outcomes per dollar spent) must become the overarching goal of health care delivery. This study and its results are an excellent example of high value in health care. The authors demonstrated that Gartland type 2 SCH fractures can be safely treated in a free-standing ASC with clinical and radiographic outcomes that are comparable to those obtained at a children’s hospital, but in a way that is faster and more cost-effective.
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