title: Evaluating healthcare resource utilization and outcomes for surgical hip dislocation and hip arthroscopy for femoroacetabular impingement.
abstract: OBJECTIVE
  Surgical hip dislocation (SHD) and hip arthroscopy are surgical methods used to correct deformity associated with femoroacetabular impingement (FAI). Though both of these approaches appear to benefit patients, no studies exist comparing healthcare resource utilization of the two surgical approaches. This systematic review examines the literature and the records of two surgeons to evaluate the resource utilization associated with treating symptomatic FAI via these two methods.
  
  
  METHODS
  EMBASE, MEDLINE and PubMed were searched for relevant articles. The articles were systematically screened, and data was abstracted in duplicate. To further supplement resource utilization data, a retrospective chart review of two surgeon's patient data (one using SHD and another using an arthroscopic approach) was completed. Experts in pharmacy, physiotherapy, radiology, anaesthesia, physiatry and the local hospital finance department were also consulted.
  
  
  RESULTS
  There were 52 studies included with a total of 460 patients (535 hips) and 3886 patients (4147 hips) who underwent SHD and arthroscopic surgery for FAI, respectively. Regardless of approach, most patients treated for symptomatic FAI improved across various outcomes measures with low complication rates. Surgical time across all approaches was similar, averaging 118 ± 2 min. On a per patient basis, hip arthroscopy ($10,976) uses approximately 41 % of the resources of SHD ($24,379).
  
  
  CONCLUSIONS
  There were no significant differences in outcomes for FAI treated with SHD or arthroscopy. However, with regard to healthcare resource utilization based on the OHIP healthcare system, hip arthroscopy uses substantially less resources than SHD within the first post-operative year.
  
  
  METHODS
  Systematic Review of Level IV Studies, Level IV.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, McMaster University, 1200 Main Street West, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: de Sa
authors.affiliation: Michael G. DeGroote School of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Horner
authors.affiliation: Michael G. DeGroote School of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Austin
authors.initials: A
authors.lastname: MacDonald
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Centre for Evidence Based Orthopaedics, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Simunovic
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, McMaster University, 1200 Main Street West, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
authors.forename: Gerard
authors.initials: G
authors.lastname: Slobogean
authors.affiliation: The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Philippon
authors.affiliation: Division of Orthopaedic Surgery, CHUQ-Hotel Dieu de Quebec, Quebec, QC, Canada.
authors.forename: Etienne L
authors.initials: EL
authors.lastname: Belzile
authors.affiliation: The department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Jon
authors.initials: J
authors.lastname: Karlsson
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, McMaster University, 1200 Main Street West, Room 4E15, Hamilton, ON, L8N 3Z5, Canada. ayenif@mcmaster.ca.
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
mesh_terms: D001182:Arthroscopy / Q000191:economics / Q000379:methods*; D057925:Femoracetabular Impingement / Q000601:surgery*; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D066231:Surgeons
keywords: Cost; Femoroacetabular impingement; Outcomes; Quality; Resource utilization