title: A comparison of outpatient and inpatient anterior cruciate ligament reconstruction surgery.
abstract: The feasibility of outpatient anterior cruciate ligament (ACL) surgery has not been reported in the literature. We evaluated outpatient ACL surgery by comparing outpatient versus inpatient pain control, narcotic consumption, postoperative complications, recovery time, and cost analysis. Thirty-seven ACL reconstructions were performed in 37 patients over a 16-month period. Twenty-five of the patients had surgery performed as outpatients and 12 as inpatients. One of the outpatients required hospitalization because of excessive nausea and vomiting and another for urinary retention. Only 2 of the 25 outpatients (8%) believed that they should have been hospitalized for pain control. Based on a visual analog scale, pain severity, pain frequency, and pain relief were measured, and no statistically significant difference (P < .05) was noted between the groups, although the data suggested that the inpatients were slightly more comfortable. There were no differences in rehabilitation or in regaining full range of motion of the operated knee. Also, the only postoperative complication in both groups occurred in an inpatient who developed arthrofibrosis. Cost analysis showed that outpatient ACL reconstruction was cost effective. The average inpatient cost was $9,220 (2.4 hospital days) compared with the average outpatient cost of $3,905. This reflected a savings of 58%. These results show that outpatient ACL reconstruction surgery is possible in the appropriate patient without harm to the patient and with a significant cost savings.
authors.affiliation: Department of Orthopedic Surgery, Kaiser Permanente Hospital, San Francisco, CA 94118, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Kao
authors.forename: C E
authors.initials: CE
authors.lastname: Giangarra
authors.forename: G
authors.initials: G
authors.lastname: Singer
authors.forename: S
authors.initials: S
authors.lastname: Martin
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D003365:Costs and Cost Analysis; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008722:Methods; D010147:Pain Measurement; D010149:Postoperative Pain; D016059:Range of Motion, Articular; D016896:Treatment Outcome