Outcomes of Inpatient Versus Outpatient Elective Foot and Ankle Surgery

Abstract

Background Complications following orthopedic surgeries are undesirable and costly. A potential method to reduce these costs is to perform traditionally inpatient surgical procedures in the outpatient setting. The purpose of this study is to compare outcomes between inpatient and outpatient settings for elective foot and ankle surgeries using the National Surgical Quality Improvement Program (NSQIP) database. Methods Patients with Current Procedural Terminology (CPT) codes specific to orthopedic foot and ankle surgery were identified from the 2011-2015 American College of Surgeons NSQIP database. Demographics, comorbidities, and complications were compared between patients undergoing inpatient and outpatient procedures. Results Patients receiving inpatient surgery were significantly older and more frequently male. Black patients were significantly more likely to undergo inpatient surgery than outpatient surgery while white patients were significantly more likely to undergo outpatient surgery. Outpatients had a significantly higher mean body mass index (BMI) than inpatients. Smokers were at a significantly greater risk of undergoing inpatient surgery than outpatient surgery. Outpatients had significantly longer operative times, were more likely to receive general anesthesia, had a lower American Society of Anesthesiologists (ASA) class, were more likely to be functionally independent, and were less likely to expire postoperatively. Patients who received surgery as an inpatient were significantly more likely to have comorbidities as compared to outpatients. The overall risk of surgical complications was significant between groups with 8.6% in the inpatient group and 2.0% in the outpatient group. The overall risk of medical complications was 16.9% in the inpatient group and 1.7% in the outpatient group. Similar to the surgical complications, inpatients were significantly more likely to sustain each of the individual medical complications except for stroke/CVA and venous thromboembolism. Conclusions Outpatient management is associated with decreased postoperative complications in select patients. Performing more operations in the outpatient setting in select patients may be beneficial for cost reduction and patient satisfaction.

Pediatric Plastic Surgery Under Local Anesthesia

“…11 These include geographic location, procedure type, overhead costs, professional fees, and equipment usage, all of which contribute to greater costs when compared with office-based operations. [12][13][14] Performing office-based procedures under local anesthesia for the care of pediatric patients provides a possible means to decrease healthcare costs, while also avoiding complications arising from the use of general anesthesia in this population. 15,16 As such, the incorporation of local anesthesia cases into pediatric procedural practices is a means of expanding financial access of care to patients and their families in a safe manner.…”

“…Factors that affect the cost of operating room time have been described previously 11 . These include geographic location, procedure type, overhead costs, professional fees, and equipment usage, all of which contribute to greater costs when compared with office-based operations 12–14 . Performing office-based procedures under local anesthesia for the care of pediatric patients provides a possible means to decrease healthcare costs, while also avoiding complications arising from the use of general anesthesia in this population 15,16 .…”

The Rise of Total Ankle Arthroplasty Use: A Database Analysis Describing Case Volumes and Incidence Trends in the United States Between 2009 and 2019

“…Surgical candidates are generally assessed for functional status, American Society of Anesthesia (ASA) classification, comorbidity, and smoking history. 5,24,30,62 Gender is not a considered criterion for TAA candidacy. Males made up more than half of inpatients and outpatients in our study cohort.…”

Inpatient admission following anterior cruciate ligament reconstruction is associated with higher postoperative complications

“…While this is the first study to compare short‐term complication rates between inpatient and outpatient ACLR, researchers and clinicians have established an extensive amount of evidence for the increased risk of short‐term complications, both surgical and medical, in patients admitted inpatient for other elective orthopedic procedures [3, 5, 14, 19, 26, 28, 35, 37, 38]. Huntley et al observed a significantly increased risk of both surgical and medical complications following inpatient foot elective foot and ankle surgery [14]. Similarly, Mulligan et al found a 31% complication rate following inpatient total ankle arthroplasty, compared to 5% in patients who underwent ambulatory surgery or those with less than 48 h of stay [28].…”