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Day-case pelvic osteotomy for developmental dysplasia of the hip
Dave M Moore1, Gerard A Sheridan1, Paula M Kelly1
1Department of Orthopaedics, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
Insights
Performing day-case pelvic osteotomies for developmental dysplasia of the hip (DDH) significantly reduces hospital bed days and saves over €3,000 per patient. This approach improves cost-effectiveness in pediatric orthopedics with proper protocols.
Area of Science:
- Pediatric Orthopedics
- Surgical Procedures
Background:
- Developmental dysplasia of the hip (DDH) often requires surgical intervention, including pelvic osteotomies.
- Traditionally, these procedures are performed as in-patient cases, utilizing significant hospital resources.
Purpose of the Study:
- To evaluate the feasibility and benefits of performing pelvic osteotomies for DDH as day-case procedures.
- To assess the financial and in-patient bed resource implications of day-case vs. in-patient models of care.
Main Methods:
- Prospective cohort study of Salter and Pemberton pelvic osteotomies for DDH (2017-2019).
- Comparison of day-case procedures (for patients within 50 km) versus in-patient procedures.
- Detailed financial costing and in-patient resource utilization analysis.
Main Results:
- 35 of 84 osteotomies were performed as day cases, reducing bed days by 70.
- Day-case procedures saved €3,082 per patient, totaling €102,696 over three years.
- Seven day-case patients required readmission due to pain control issues, but were discharged the next day.
Conclusions:
- Day-case pelvic osteotomies are effective in reducing in-patient bed days in pediatric orthopedics.
- Significant cost savings are achievable, enhancing the cost-effectiveness of DDH management.
- Successful implementation requires clear protocols and close clinical follow-up.
Purpose:
In this article we report the results of a pilot study analysing the implications of performing pelvic osteotomies for developmental dysplasia of the hip (DDH) as a day case. We assess the advantages of performing paediatric pelvic osteotomies as day-case procedures from a financial perspective and from an in-patient bed resource point of view.
Methods:
This was a prospective cohort study analysing Salter and Pemberton pelvic osteotomies performed for DDH over a three-year period from 1st January 2017 to 30th September 2019. All patients residing within 50 km of the hospital were eligible for day-case procedures. All other cases were performed as in-patients. A detailed financial costing analysis was performed and the in-patient resources utilized were documented and compared between the two models of care.
Results:
In total, 84 Salter and Pemberton osteotomies were performed between 1st January 2017 to 30th September 2019. Of these cases, 35 were performed as day-case procedures. A total reduction in 70 in-patient bed days was reported. Total costs for a single in-patient requiring two nights of admission amounted to €5,752, whereas the discharge cost of a day case was reported at €2,670. The savings made by our institution amounted to €3,082 per day case. A total saving of €102,696 was made over three years. In all, seven day-case patients re-attended due to inadequate pain control. They required overnight admission and were discharged uneventfully the following day.
Conclusion:
Day-case pelvic osteotomies significantly reduce the number of in-patient bed days used in an elective paediatric orthopaedic setting. Significant financial savings in excess of €3,000 per case are possible. The introduction of day-case pelvic osteotomy procedures can significantly improve the cost-effectiveness of managing DDH provided there are clear protocols in place with close clinical follow-up.
Level Of Evidence:
IV.
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