Archive Orthopedic Surgery 2019

Should You Be in the Business of Fixing Fractures?

Outpatient trauma care is a cost-effective and patient-satisfying option for repairing minor breaks.

Kendal Gapinski

Kendal Gapinski, Contributing Editor

BIO

BROKEN SYSTEM
Pamela Bevelhymer, RN, BSN, CNOR
BROKEN SYSTEM More surgeons are choosing to take care of orthopedic trauma cases in outpatient ORs as a way to improve patient care.

Increasing numbers of patients with broken ankles, cracked fingers and busted wrists have the injuries splinted in emergency rooms before undergoing fracture repair surgery in outpatient ORs. "There are a few reasons why," says Anthony A. Romeo, MD, chief of orthopedics at the Rothman Orthopaedic Institute in New York, N.Y. "First and foremost, there is a high level of patient satisfaction. The other reason is value. We can provide the same or better outcomes in an ambulatory setting at a fraction of the cost."

Research backs up that claim. A recent study including 61 patients who had ankle fractures — among the most common traumatic orthopedic injuries — surgically repaired at a tertiary referral hospital and 81 patients who received treatment in the hospital's surgery center says outpatient ankle fracture repairs cost 31.6% less than inpatient cases (osmag.net/B8SgcU).

"The main factors contributing to the higher costs were the labor and facility expenses," says study co-author Clayton C. Bettin, MD, an orthopedic surgeon at Campbell Clinic Orthopaedics in Memphis, Tenn. "We also found there were no differences in rates of reoperation, readmission or return visits to the ER for patients treated on an inpatient or outpatient basis."

Another study comparing the costs of inpatient and outpatient fracture repairs says routine hospitalizations for ankle repair surgery result in about $367 million in facility reimbursements each year. In 2012, according to the study, inpatient ankle surgeries resulted in nearly $8 million in facility reimbursements, compared with a little more than $4 million in payments to outpatient facilities for treatment of the same injuries. The study notes that a greater understanding of the economic implications of inpatient ankle fracture surgery could lead to more procedures being performed on an outpatient basis.

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