Abstract
Introduction
Traditionally an inpatient hospital stay has been required for all joint replacement surgery. The three primary drivers of cost for joint replacement have been implant cost, other hospital charges and postoperative rehabilitation costs. The three primary reasons that have made hospitalization necessary are pain control, therapy and possible transfusion. Advances in surgical technique, implants, comprehensive blood management, and multimodal pain management have allowed a marked reduction in the hospital stay required, eliminated the need for extensive formal rehabilitation. The purpose of this study is to evaluate if hip resurfacing can be performed safely and cost-effectively as an outpatient procedure.
Methods
We present the short-term outcome of our first 77 hip resurfacings done as an outpatient procedure performed by two experienced surgeons. Young patients without major medical co-morbidities were selected. The average age was 53±6 years old (range: 38 to 66), there were 57 men and 20 women. The mean ASA score was 1.6±0.5 (range 1 to 2). The diagnosis was OA in 56, dysplasia in 17, avascular necrosis in 2, and others in 2.
Results
All patients were successfully discharged on the day of surgery from our physician-owned outpatient surgery center. There were no major complications noted in the first 6 weeks postoperative. There was one ER visit, and there were no hospitalizations required. The average and highest pain score for each day was shown in Figure 1 for the first 5 days postoperative. Three patients required a morphine injection after discharge from the surgery center. No patients required a transfusion. The cost comparison is obtained from the Blue Cross website which indicates that the “120 day episode of care” cost for hip replacement was $35,000 at Providence, $ 45,000 at Palmetto, $65,000 at Lexington hospital, while cost at our surgery center was $26,000. This represents a cost savings for the insurance company of nearly $9,000 (26%) compared to the lowest cost and $39,000 (60%) compared to the highest cost hospital in our region.
Conclusion
We conclude that in properly selected patients, outpatient hip resurfacing can be accomplished safely, with a high degree of patient satisfaction and a tremendous cost savings to the insurer. We suspect that indications can be gradually expanded to allow more patients to take advantage of this option. If insurers could find creative ways to incentivize patients to take advantage of the highest quality, lowest cost options, tremendous health care savings are possible in a free-market health care model free of excessive government regulations and price controls.
