How to reduce the cost of hindfoot fusion

The purpose of this study was to determine whether modification of a surgical practice by using regional anesthesia and local bone grafting would yield the same surgical results as traditional anesthesia and iliac crest bone graft, with a cost reduction. All patients were matched by preoperative disease and were assessed to determine satisfaction and complications. The length of stay for the seven matched pairs of patients undergoing subtalar arthrodesis decreased significantly, as did blood loss, total operating room time, and tourniquet time. The average cost saving was $7844. Similar data were found for the nine matched pairs of patients who underwent triple arthrodesis, blood loss, and tourniquet time. Total cost was again found to be significantly lower by an average of $9302 in the study group. The most dramatic changes between the two groups were demonstrated in the patients who underwent ankle fusions. The 10 matched pairs showed a marked reduction in length of stay, with a decrease in estimated blood loss from 260 mL to 92 mL (P < 0.05). The total operating room time and tourniquet time in these two groups were similar. There was a cost savings in the study group of $9888, with no increase in complications. The use of longacting regional anesthesia and local bone grafting enabled surgeons to perform hindfoot arthrodeses on an outpatient basis, with a significant reduction in cost to the patient and no increase in complications.