New research presented at the American Orthopaedic Foot and Ankle Surgeons Annual Meeting suggests that total ankle replacement operations performed at outpatient ambulatory surgical centers offered significant cost savings compared to inpatient facilities.
“Performing total ankle replacement in ambulatory surgery centers is cost-effective,” said Christopher E Gross, MD, in an interview with Orthopedics Today. “We encourage hospitals to try to emulate the efficiency of ambulatory settings for elective procedures.”
Total Ankle Replacement Cost Savings
For their study, Dr. Gross and colleagues examined 574 total ankle replacements performed at either inpatient centers or ambulatory surgical centers between 2011 and 2014. Researchers looked at a number of relevant factors in each operation, including total cost, operation duration, patient age, gender, additional health conditions, the type of implant used and the specific operation performed. After looking at the data and grouping the data sets based on where the operation was performed, researchers uncovered:
- Inpatient facilities had higher total costs per patient of about $4,000 compared to ambulatory surgical centers.
- Significant cost drivers in this cost increase included: inpatient services, pharmacy costs, physical and occupational therapy, lab fees, radiology and the cost of the surgical implant.
- Researchers noted that anesthesia costs were higher in the outpatient group, noting that they “were thinking that maybe it is due to the fact that certified registered nurse anesthesiologists are populating the outpatient group. The anesthesiologist would be the person on-call making sure that people were doing well in the middle of the night at the ambulatory surgery center.”
- The team concluded that the government could save a huge amount of money if patients had gone to outpatient surgical centers for their total ankle replacement, or if inpatient facilities could look towards outpatient centers for ways to reduce their total costs.
“If all of those patients were to have their total ankle replacement done an in ambulatory surgery setting as opposed to the inpatient setting during that 4-year period, the government would have saved about $1.5 million,” Dr. Gross said.
Dr. Gross said the results of the study were not all that surprising, and he hopes to conduct future studies to determine if outpatient centers are more efficient with their time management compared to inpatient centers.
“This may show where this is room for improvement and where hospitals can try to imitate the ambulatory surgical centers,” Dr. Gross said.
Lastly, he also wants to conduct follow up studies with the patients in this study to see if surgery at one center produced significantly better patient outcomes compared to the other.
“Hopefully, we can use that data to demonstrate that total ankle replacements can be done in the outpatient setting similar to how total knees have gotten to that point,” Dr. Gross concluded.