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The cost of outpatient versus inpatient total hip arthroplasty: a randomized trial
Bryn O Zomar1, Jacquelyn D Marsh2, Dianne M Bryant1
1From the Faculty of Health Sciences, Western University, London, Ont. (Zomar, Marsh, Bryant); the Bone and Joint Institute, Western University, London, Ont. (Zomar, Marsh, Bryant, Lanting); the Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ont. (Lanting); and the Schulich School of Medicine & Dentistry, Western University, London Ont. (Lanting).
Insights
Outpatient total hip arthroplasty (THA) may reduce healthcare costs. This study found outpatient THA to be more cost-effective than inpatient procedures, with similar adverse event rates.
Area of Science:
- Orthopedic Surgery
- Health Economics
Background:
- Rising costs of total hip arthroplasty (THA) necessitate exploring cost-saving strategies.
- Outpatient THA, involving same-day discharge, is a potential approach to mitigate these expenses.
Purpose of the Study:
- To compare the economic impact of outpatient THA versus traditional inpatient THA.
Main Methods:
- A preliminary analysis of a randomized controlled trial involving primary THA via direct anterior approach.
- Participants were randomized to same-day or 1-day post-surgery discharge.
- Cost and patient-reported outcome measures (WOMAC) were assessed at multiple time points.
Main Results:
- The study included 115 participants; adverse event rates were comparable between outpatient and inpatient groups.
- Outpatient THA demonstrated lower costs from both healthcare payer and societal perspectives.
- While WOMAC scores were slightly higher in the outpatient group at 12 weeks, the cost savings were significant.
Conclusions:
- Outpatient THA appears to be a cost-saving alternative to inpatient THA.
- Further research with larger sample sizes is recommended to refine cost estimates.
Background:
One route to mitigate the increasing costs of total hip arthroplasty (THA) is outpatient THA, discharging patients on the same day as their surgery. The purpose of this study was to compare the cost of outpatient THA to standard overnight stay in hospital.
Methods:
This was a preliminary analysis of the first group of patients to complete follow-up in a larger randomized controlled trial among patients who underwent primary THA through a direct anterior approach between June 2015 and November 2017. The study was conducted at a single centre among patients of 1 fellowship-trained arthroplasty surgeon. We randomly allocated participants to be discharged either as outpatients or on postsurgery day 1 using a modified Zelen consent model. Adverse events were recorded. Participants completed cost questionnaires 2, 6 and 12 weeks after surgery, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 12 weeks after surgery. We performed cost analyses from health care payer and societal perspectives.
Results:
A total of 115 participants completed this study, 49 allocated to the outpatient group and 56 to the inpatient group. The adverse event rate was similar for the 2 groups. The WOMAC total score and function subscale score were higher for the outpatient group than the inpatient group at 12 weeks (mean difference 2.1, 95% confidence interval [CI] 0.0 to 4.1, and 6.5, 95% CI 0.4 to 12.5, respectively). From both a health care payer and a societal perspective, inpatient THA was more costly than outpatient THA (mean difference $1006.86, 95% CI -$2158.92 to $145.21, and $1667.40, 95% CI -$3856.64 to $521.84, respectively).
Conclusion:
Our results suggest that outpatient THA may be a cost-saving procedure compared to inpatient THA from both health care payer and societal perspectives. Further study with larger samples is needed to provide more precision around our estimates.
Trial Registration:
ClinicalTrials.gov, no. NCT03026764.
