Ambulatory versus inpatient shoulder arthroplasty: a population-based analysis of trends, outcomes, and charges

JSES International

Susan Odum, PhD¹  Patrick M. Connor, MD²  Gabriella E. Ode, MD³  Nady Hamid, MD⁴ 

[1] Corresponding author: Gabriella E. Ode, MD, 309 E 1st Ave, Easley, SC 29640, USA.;Atrium Health Musculoskeletal Institute, Charlotte, NC, USA;Department of Orthopaedic Surgery, Prisma Health - Upstate, Greenville, SC, USA;OrthoCarolina Sports Medicine Center, Charlotte, NC, USA;

关键词: Outpatient;    inpatient;    shoulder arthroplasty;    charges;    risk stratification;    database;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: The purpose of this study was to evaluate the clinical outcomes and cost of shoulder arthroplasty (SA) performed in ambulatory surgery centers (ASCs) compared with SA performed in hospital-based surgery settings. Methods: The State Inpatient Databases and the State Ambulatory Surgery Databases were queried for patients undergoing primary or reverse SA between 2010 and 2014 in 5 states in either the inpatient (IP), hospital outpatient department (HOPD), or ASC setting. Outcomes included all-cause readmissions, emergency department visits within the 90-day postoperative period, and charges. Covariates included patient demographic data and procedure details. Risk factors for readmission were calculated using logistic regression analysis. Results: We identified 795 ASC (2%), 183 HOPD (0.5%), 38,114 (97.5%) SA procedures. The outpatient cohort was overall younger and healthier with a lower percentage of diabetes (14.1% vs. 20.2%), cardiopulmonary disease (11.4% vs. 20.4%), and obesity (10.7% vs. 15.6%). The US state and obesity were factors significantly (P < .0001) associated with readmission. The median IP charge was $62,905 (range, $41,327-$87,881) vs. $37,395 (range, $21,976-$61,775) for combined outpatient cases. When outpatient SA was stratified into ASC and HOPD cases, the median charges were $31,790 for ASC cases vs. $55,990 for HOPD cases (P < .0001). After adjustment for multiple covariates, the charges for combined outpatient SA surgery were 40% lower than those for IP SA surgery (P < .0001). Conclusion: As the current health care climate shifts toward lower-cost and higher-quality care, this study demonstrates that SAs performed in ASCs have a comparable safety profile to and significant financial advantage over SAs performed in the hospital-based setting.

【 授权许可】

Unknown