Utilization of a Standardized Care Pathway to Decrease Costs of Ankle Fracture Management

Abstract

Introduction: Ankle fractures are the most common fracture of the foot and ankle treated at trauma hospitals in the United States, costing millions of dollars yearly. The purpose of this study was to determine whether a standardized care pathway led to a difference in the direct and indirect costs of surgical fixation of ankle fractures at one Level I Trauma Center and tertiary care medical center. Methods: We analyzed cost, volume, length of stay, and collections for surgical treatment of ankle fractures in inpatient and outpatient settings by the orthopaedics and podiatry departments during fiscal years 2016 to 2018. Based on these data, we compared projected costs and collections across a 5-year period with the procedure being done by a single department (orthopaedics only and podiatry only). Results: Total costs per case fell by 18% in the orthopaedics department and 8% in the podiatry department over the 3-year period. The podiatry department spent an average of $1,296 (46%) more per case than the orthopaedics department, driven by increased average supply costs. Both departments had significantly decreased direct costs (P = 0.0039 orthopaedics and P = 0.033 podiatry) in the outpatient setting. The orthopaedics department also had significantly lower average supply costs than the podiatry department (P = 0.045) and significantly decreased total costs in the outpatient setting (P = 0.0084). Discussion: The orthopaedics department performed a higher volume of cases at a lower cost per case than the podiatry department. These savings were driven by a standardized ankle fracture treatment pathway that we propose decreased direct and supply costs. Our results suggest that surgical treatment of ankle fracture cases using a standardized care pathway is economically advantageous because of limiting variations in care and creating manageable workflows.

Inpatient or Outpatient: Does Initial Disposition Affect Outcomes in Trimalleolar Ankle Fractures?

“…However, a paucity of studies evaluating such pathways for ankle fracture patients specifically exists. One example of an effective ankle fracture pathway has been published by Duckworth et al [ 9 ]. By implementing a standardized approach that included inpatient admission of unstable, high energy, and/or open fractures; medically or socially unstable patients requiring surgery; and discharge with the outpatient treatment of stable, low energy, closed fractures, the authors demonstrated a cost per case reduction of 18% over three years.…”

“…Admission and inpatient repair are associated with an increase in healthcare costs compared to outpatient management, which may place a strain on healthcare resources [ 7 , 8 ]. While significant variability in ankle fracture management exists broadly, one study determined that costs can be decreased when ankle fractures are approached using a standardized care pathway [ 9 ]. Similarly, a structured approach to outpatient management may preserve healthcare resources with minimal effect on infection risk and negative outcomes for closed ankle fractures [ 10 ].…”

Fractures of the lateral malleolus – a retrospective before-and-after study of treatment and resource utilization following the implementation of a structured treatment algorithm

“…The aim of introducing a structured TA for ankle fracture management was to clarify the indications for surgical treatment. This was thought to reduce the number of operations and subsequent complications to surgery and optimize resource consumption (7). Another aim of the TA was to limit weight-bearing restrictions and reduce unnecessary radiographic examinations for stable isolated lateral malleolar fractures, as this has been shown not to be necessary (8,9).…”