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A long-term experience of day-case pelvic osteotomy for developmental dysplasia of the hip
Dave M Moore1, Catherine Howells1, Olga Gallagher1
1Department of Trauma and Orthopaedic Surgery, Childrens Health Ireland, Crumlin, Cooley Rd, Crumlin, Dublin, D12 N512, Ireland.
Insights
Day-case pelvic osteotomies for developmental hip dysplasia (DDH) are safe and cost-effective. This initiative significantly reduces hospital bed demand, saving nearly €4000 per patient.
Area of Science:
- Orthopaedic Surgery
- Paediatric Orthopaedics
- Developmental Dysplasia of the Hip (DDH)
Background:
- Developmental hip dysplasia (DDH) has a high incidence, leading to substantial orthopaedic referrals.
- Optimizing paediatric orthopaedic service efficiency is crucial due to high demand.
- This study evaluates a novel day-case pelvic osteotomy approach.
Purpose of the Study:
- To assess the long-term experience and outcomes of day-case pelvic osteotomies for DDH.
- To identify potential complications associated with day-case pelvic osteotomies.
- To compare the cost-effectiveness of day-case versus in-patient pelvic osteotomies.
Main Methods:
- A non-randomized prospective cohort study was conducted.
- Compared conventional in-patient pelvic osteotomies with day-case osteotomies.
- Data collected from January 2017 to November 2023 at a tertiary national referral centre.
Main Results:
- 164 pelvic osteotomies (Salter and Pemberton) were performed; 115 met day-case criteria.
- Day-case osteotomies cost €2670 per patient, compared to €6619 for in-patients.
- A total saving of €434,390 was achieved for 110 day-cases, averaging €3949 saved per case.
Conclusions:
- Day-case pelvic osteotomy for DDH is a safe and cost-effective surgical option.
- This approach significantly reduces the demand on in-patient hospital bed resources.
- Long-term review supports the continued implementation of this initiative.
Objective:
Developmental hip dysplasia has an incidence of 6.73 per 1000 live births and leads to a significant number of orthopaedic referrals annually. This high demand has encouraged the drive to optimize the efficiency of service provision in the paediatric orthopaedic setting. Here we describe our long-term experience with a novel day-case pelvic osteotomy initiative. We also describe any potential complications one can expect when performing day-case pelvic osteotomies.
Methods:
This was a non-randomized prospective cohort study conducted to compare conventional in-patient pelvic osteotomies with day-case osteotomies performed between January 2017 and November 2023. All surgeries took place at an urban tertiary national referral centre by four paediatric orthopaedic surgeons with a specialist interest in DDH.
Results:
164 Salter and Pemberton osteotomies were performed of which 115 met the day-case criteria. Based on the HSE 'Specialty Costing Report' and 'Annual Report and Financial Statements', the total discharge cost for patients undergoing an in-patient osteotomy was €6619 in contrast to €2670 per day-case patient. For the 110 day-cases, the cost to treat amounted to €293,700; hence, there was a total saving of €434,390 made by the hospital for the 110 day-cases performed. This amounts to €3949 saved for every day-case.
Conclusion:
Review at 7 years has demonstrated that day-case pelvic osteotomy surgery for DDH remains a safe and cost-effective initiative that significantly reduces the demand on in-patient hospital bed resources.
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