Summary

Same day discharge for knee osteotomies is a safe option for patients with significant cost savings, with no significant difference in 30-day Emergency Department reattendance, 30-day readmission, 6-month complication rate or 6-month reoperation rate compared with inpatient care.

Abstract

Introduction

High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) can be effective treatments to correct lower limb alignment for the management of symptomatic compartments and unicompartmental knee osteoarthritis in young active patients. Worldwide, they are usually performed as an inpatient procedure. Recently there has been an increasing emphasis on same-day discharge (SDD) in orthopaedics. The benefits of SDD are not limited to clinical outcomes, but also advantageous to the healthcare systems especially in resource-stressed environments by freeing up inpatient bed capacity and offering cost savings. However, there is limited evidence on the safety and cost-efficacy of SDD knee osteotomy.

Purpose

To investigate the success of SDD for knee osteotomy compared with inpatient care, with a focus on safety and associated costs.

Methods

A retrospective study was performed of all patients in our institution who had a primary HTO or DFO from June 2020 with minimum of 6-month follow-up. The key parameters recorded were the success of SDD in patients booked for one-day care, 30-day emergency department (ED) attendances, 30-day readmissions, 6-month complication rates, 6-month re-operation rates and total provider costs. Participants were divided into three groups based on facility and admission type: University Hospital (UH) Overnight Stay (UH OS), UH SDD and Ambulatory Surgery Centre (ASC) SDD. The absolute risk of all clinical outcomes and the risk difference between groups were calculated to compare clinical outcomes using the chi-square test of independence. Mean total provider care cost was calculated for each group and compared using an analysis of variance (ANOVA).

Results

A total of 586 patients (401 males; 68%) with a mean age of 50.5 years (range, 15-77 years) were included. 355 patients had surgery at UH as OS, 157 patients at UH as SDD and 74 patients at SC as SDD. Successful SDD at ASC was achieved in 100% (74/74) of patients at ASC and 90.4% (142/157) patients at UH. The absolute risk of 30-day ED attendances was 2.8%, 1.9%, 6.8% (p=0.12) and the absolute risk of 6-month complications was 5.6%, 4.5%, 5.4% (p=0.86) in UH OS, UH SDD and ASC SDD, respectively. There was no significant difference in 6-month re-operation rate between the groups. No patients were re-admitted within 30 days. Costing data was available for 495 patients. There were significant differences in mean total provider care costs between all groups. ASC SDD offered the most significant cost reductions (total avg. cost $2338.46 ± 409.97), compared with both UH OS ($7768.96 ± 1967.30, p-value < 0.001) and UH SDD ($6516.16 ± 1802.31, p-value < 0.001).

Conclusion

SDD for knee osteotomies is a safe option for patients, with no significant difference in 30-day ED reattendance, 30-day readmission, 6-month complication rate or 6-month reoperation rate compared with inpatient care. Additionally, there is a significant cost saving for SDD at our Ambulatory Surgery Centre versus Hospital Setting. Therefore, if patient factors allow, SDD for patients undergoing knee osteotomy should be considered.