title: An Expedited Care Pathway with Ambulatory Brachial Plexus Analgesia Is a Cost-effective Alternative to Standard Inpatient Care after Complex Arthroscopic Elbow Surgery: A Randomized, Single-blinded Study.
abstract: BACKGROUND
  Common standard practice after complex arthroscopic elbow surgery includes hospital admission for 72 h. The authors hypothesized that an expedited care pathway, with 24 h of hospital admission and ambulatory brachial plexus analgesia and continuous passive motion at home, results in equivalent elbow range of motion (ROM) 2 weeks after surgery compared with standard 72-h hospital admission.
  
  
  METHODS
  A randomized, single-blinded study was conducted after obtaining approval from the research ethics board. Forty patients were randomized in a 1:1 ratio using a computer-generated list of random numbers into an expedited care pathway group (24-h admission) and a control group (72-h admission). They were treated equally aside from the predetermined hospital length of stay.
  
  
  RESULTS
  Patients in the control (n = 19) and expedited care pathway (n = 19) groups achieved similar elbow ROM 2 weeks (119 ± 18 degrees and 121 ± 15 degrees, P = 0.627) and 3 months (130 ± 18 vs. 130 ± 11 degrees, P = 0.897) postoperatively. The mean difference in elbow ROM at 2 weeks was 2.6 degrees (95% CI, -8.3 to 13.5). There were no differences in analgesic outcomes, physical function scores, and patient satisfaction up to 3 months postoperatively. Total hospital cost of care was 15% lower in the expedited care pathway group.
  
  
  CONCLUSIONS
  The results suggest that an expedited care pathway with early hospital discharge followed by ambulatory brachial plexus analgesia and continuous passive motion at home is a cost-effective alternative to 72 h of hospital admission after complex arthroscopic elbow surgery.
authors.affiliation: From the Departments of Anesthesia and Pain Management (H.C.E., S.R., N.A., A.U.N., K.J.C., V.W.S.C., A.P.), and Surgery (C.V.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Hillenn
authors.initials: H
authors.lastname: Cruz Eng
authors.forename: Sheila
authors.initials: S
authors.lastname: Riazi
authors.forename: Christian
authors.initials: C
authors.lastname: Veillette
authors.forename: Noam
authors.initials: N
authors.lastname: Ami
authors.forename: Ahtsham U
authors.initials: AU
authors.lastname: Niazi
authors.forename: Ki Jinn
authors.initials: KJ
authors.lastname: Chin
authors.forename: Vincent W S
authors.initials: VW
authors.lastname: Chan
authors.forename: Anahi
authors.initials: A
authors.lastname: Perlas
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000698:Analgesia / Q000191:economics / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D001182:Arthroscopy; D001917:Brachial Plexus / Q000187:drug effects*; D003362:Cost-Benefit Analysis; D004209:Disposable Equipment; D004550:Elbow / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D007260:Infusion Pumps; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010098:Oxycodone / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016059:Range of Motion, Articular; D016037:Single-Blind Method
chemical_list: D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D010098:Oxycodone; D007213:Indomethacin