Orthopaedic Specialty Hospitals Compared with General Hospitals

Abstract

Background:Theoretically, orthopaedic specialty hospitals (OSHs) offer multiple advantages compared with general hospitals; however, their overall benefit is debated. This review aims to compare patient characteristics and outcomes between OSHs and general hospitals in the United States.Methods:A systematic review was performed by querying PubMed and Embase from inception to April 2020 for articles comparing patient characteristics and clinical and economic outcomes between OSHs and general hospitals. Two researchers reviewed the articles according to prespecified criteria.Results:The literature review yielded 3,715 articles, of which 19 were included. All articles were retrospective in nature. There were conflicting results with regard to preferential patient selection and profitability. OSHs generate a greater surgical volume, while decreasing operative time and length of stay, compared with general hospitals. Adverse outcomes have been reported to be less common at OSHs; however, this benefit is not supported by recent matched-cohort studies. Only 1 study evaluated patient satisfaction, and this study demonstrated improved satisfaction with OSHs.Conclusions:The literature with regard to OSHs is limited by low-quality studies, often yielding inconsistent results. OSHs appear to offer some benefits; however, it is unclear if improved outcomes are due to better patient care or preferential patient selection.

Reimbursement of Lumbar Fusion at an Orthopaedic Specialty Hospital Versus Tertiary Referral Center

“…Patients who undergo surgery at an OSH are usually younger with lower comorbidity burdens due to risk stratification protocols undertaken before surgical scheduling. 7,9,17 Although "cherry picking" young, healthy patients is a common criticism of OSHs, our study attempts to minimize this bias by matching for several variables including age, CCI, and type of procedure performed. Because the OSH has fewer critical care resources, there is a low threshold to transfer unstable patients to the TRC if a complication develops.…”

“…The results suggest that lumbar fusion performed at an OSH reduces Medicare reimbursement (i.e., results in cost savings per episode of care), largely due to lower post-acute care costs. Patients who undergo surgery at an OSH are usually younger with lower comorbidity burdens due to risk stratification protocols undertaken before surgical scheduling 7,9,17 . Although “cherry picking” young, healthy patients is a common criticism of OSHs, our study attempts to minimize this bias by matching for several variables including age, CCI, and type of procedure performed.…”

Reasons for transfer and subsequent outcomes among patients undergoing elective spine surgery at an orthopedic specialty hospital

“…Specialty hospitals have become increasingly common in the era of cost-effective healthcare. [ 1 ] Since the 1990s, the number of surgical specialty hospitals has more than tripled. [ 2 ] Specialty hospitals offer many of the advantages in patient experience that exist in ambulatory surgical centers, but they also have the additional benefit of standard inpatient postoperative services which reduce the economic burden of healthcare relative to general hospitals.…”