Skip to main content

Advertisement

SpringerLink
Log in

Outpatient lower extremity fracture surgery: should we be concerned?

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

With rising healthcare costs and insurance push against non-emergent hospital admission, lower extremity fracture treatment is shifting toward outpatient procedures over inpatient hospitalizations. This study compares outcomes for fractures treated as inpatient versus outpatient.

Methods

We conducted a retrospective review of lower extremity fracture patients. We collected demographics, injury information, hospital course, and complication data. Length of stay was categorized as “inpatient” and “outpatient” based a 24-h hospital stay cutoff. Data analysis included differences between cohorts with regards to readmissions and complications.

Results

We identified 229 patients who met inclusion criteria. Inpatient versus outpatient status was predictive of in-hospital complications; however, inpatient versus outpatient status did not predict 1-year readmission.

Conclusion

Outpatient surgery is safe and effective. As the population increases and ages, low-risk surgeries should be considered for outpatient rather than inpatient stays to lower costs, save resources, and reduce complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Code and data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Kaye JA, Jick H (2004) Epidemiology of lower limb fractures in general practice in the United Kingdom. Inj Prev 10(6):368–374. https://doi.org/10.1136/ip.2004.005843

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Castelli A, Daidone S, Jacobs R, Kasteridis P, Street AD (2015) The determinants of costs and length of stay for hip fracture patients. PLoS ONE 10(7):e0133545. https://doi.org/10.1371/journal.pone.0133545

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Centers for Disease Control and Prevention: National Center for Health Statistics (2018) Hospital admissions, average length of stay, outpatient visits, and outpatient surgery, by type of ownership and size of hospital: United States, selected years 1975–2014. Centers for Disease Control and Prevention

  4. Sambrook P, Cooper C (2006) Osteoporosis. The Lancet 368(9529):2010–2018. https://doi.org/10.1016/S0140-6736(06)68891-0

    Article  CAS  Google Scholar 

  5. Johnell O, Kanis JA, Jonsson B, Oden A, Johansson H, De Laet C (2005) The burden of hospitalised fractures in Sweden. Osteoporos Int 16(2):222–228. https://doi.org/10.1007/s00198-004-1686-2

    Article  CAS  PubMed  Google Scholar 

  6. Zhu Y, Liu S, Chen W, Liu B, Zhang F, Lv H, Ji C, Zhang X, Zhang Y (2019) Epidemiology of low-energy lower extremity fracture in Chinese populations aged 50 years and above. PLoS ONE 14(1):e0209203. https://doi.org/10.1371/journal.pone.0209203

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Wilson C (1999) The impact of medical technologies on the future of hospitals. BMJ 319(7220):1287

    Article  CAS  Google Scholar 

  8. Han XG, Tian W (2019) Artificial intelligence in orthopedic surgery: current state and future perspective. Chin Med J (Engl) 132(21):2521–2523. https://doi.org/10.1097/CM9.0000000000000479

    Article  Google Scholar 

  9. Bai L, Yang J, Chen X, Sun Y, Li X (2019) Medical robotics in bone fracture reduction surgery: a review. Sensors. https://doi.org/10.3390/s19163593

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tian L, Tang N, Ngai T, Wu C, Ruan Y, Huang L, Qin L (2019) Hybrid fracture fixation systems developed for orthopaedic applications: a general review. J Orthop Translat 16:1–13. https://doi.org/10.1016/j.jot.2018.06.006

    Article  CAS  PubMed  Google Scholar 

  11. Gonzalez T, Fisk E, Chiodo C, Smith J, Bluman EM (2017) Economic analysis and patient satisfaction associated with outpatient total ankle arthroplasty. Foot Ankle Int 38(5):507–513. https://doi.org/10.1177/1071100716685551

    Article  PubMed  Google Scholar 

  12. Huang A, Ryu JJ, Dervin G (2017) Cost savings of outpatient versus standard inpatient total knee arthroplasty. Can J Surg 60(1):57–62. https://doi.org/10.1503/cjs.002516

    Article  PubMed  PubMed Central  Google Scholar 

  13. Aynardi M, Post Z, Ong A, Orozco F, Sukin DC (2014) Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study. HSS J 10(3):252–255. https://doi.org/10.1007/s11420-014-9401-0

    Article  PubMed  PubMed Central  Google Scholar 

  14. U.S. Centers for Medicare & Medicaid Services (2019) national health expenditure data: historical. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical. Accessed February 23 2020

  15. Bertin KC (2005) Minimally invasive outpatient total hip arthroplasty: a financial analysis. Clin Orthop Relat Res 435:154–163. https://doi.org/10.1097/01.blo.0000157173.22995.cf

    Article  Google Scholar 

  16. Meneghini RM, Ziemba-Davis M, Ishmael MK, Kuzma AL, Caccavallo P (2017) Safe selection of outpatient joint arthroplasty patients with medical risk stratification: the “outpatient arthroplasty risk assessment score.” J Arthroplasty 32(8):2325–2331. https://doi.org/10.1016/j.arth.2017.03.004

    Article  PubMed  Google Scholar 

  17. Qin C, Dekker RG, Blough JT, Kadakia AR (2016) Safety and outcomes of inpatient compared with outpatient surgical procedures for ankle fractures. J Bone Joint Surg Am 98(20):1699–1705. https://doi.org/10.2106/JBJS.15.01465

    Article  PubMed  Google Scholar 

  18. Qin C, Dekker RG, Helfrich MM, Kadakia AR (2018) Outpatient management of ankle fractures. Orthop Clin North Am 49(1):103–108. https://doi.org/10.1016/j.ocl.2017.08.012

    Article  PubMed  Google Scholar 

  19. Malik AT, Quatman CE, Khan SN, Phieffer LS, Rao P, Ly TV (2019) Outpatient versus inpatient surgical fixation of isolated ankle fractures: an analysis of 90-day complications, readmissions, and costs. J Foot Ankle Surg. https://doi.org/10.1053/j.jfas.2019.09.030

    Article  PubMed  Google Scholar 

Download references

Funding

The authors did not receive grant support or research funding for this study. The authors did not receive any proprietary interests in the materials described in the article.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA

    Charlotte N. Shields, Sara Solasz, Leah J. Gonzalez, Yixuan Tong & Kenneth A. Egol

  2. Jamaica Hospital Medical Center, Queens, NY, USA

    Sanjit R. Konda & Kenneth A. Egol

Authors
  1. Charlotte N. Shields
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Solasz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leah J. Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yixuan Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sanjit R. Konda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenneth A. Egol
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CNS & SS: Conducted the chart review, data analysis, and writing of the manuscript. KAE & SRK: Devised the project and main conceptual ideas. Helped in the writing of the manuscript. LJG: Conducted data analysis and writing of the manuscript. YT: Conducted the chart review. All authors provided critical feedback and helped shape the research, analysis, and manuscript.

Corresponding author

Correspondence to Kenneth A. Egol.

Ethics declarations

Conflict of interest

CNS, SS, LJG, YT: The authors declare that they have no conflict of interest. SRK: OTA committee member; Paid consultant, speaker, and research support from Stryker. KAE: Research support from Acumed and Synthes; Paid consultant for Exatech, Inc; OTA committee member; Unpaid consultant for Polypid; Financial support from SLACK Inc; Paid presenter for Smith & Nephew; Publishing royalties from Wolters Kluwer Health—Lippincott Williams & Wilkins.

Ethical approval

This study was approved by the NYU School of Medicine Institutional Review Board (Study Number: i19-00611).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shields, C.N., Solasz, S., Gonzalez, L.J. et al. Outpatient lower extremity fracture surgery: should we be concerned?. Eur J Orthop Surg Traumatol 32, 719–723 (2022). https://doi.org/10.1007/s00590-021-03029-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-021-03029-6

Keywords

Search

Navigation