title: A cost analysis of orthopedic foot surgery: can outpatient continuous regional analgesia provide the same standard of care for postoperative pain control at home without shifting costs?
abstract: OBJECTIVE
  Same-day surgery is common for foot surgery. Continuous regional anesthesia for outpatients has been shown effective but the economic impact on the perioperative process-related healthcare costs remains unclear.
  
  
  METHODS
  One hundred twenty consecutive patients were included in this assessor-blinded, prospective cohort study and allocated according to inclusion criteria in the day-care or in the in-patient group. Standardized continuous popliteal sciatic nerve block was performed in both groups for 48 h using an elastomeric pump delivering ropivacaine 0.2 % at a rate of 5 ml/h with an additional 5 ml bolus every 60 min. Outpatients were discharged the day of surgery and followed with standardized telephone interviews. The total direct health costs of both groups were compared. Moreover, the difference in treatment costs and the difference in terms of quality of care and effectiveness between the groups were compared.
  
  
  RESULTS
  Total management costs were significantly reduced in the day-care group. There was no difference between the groups regarding pain at rest and with motion, persistent pain after catheter removal and the incidence of PONV. Persistent motor block and catheter inflammation/infection were comparable in both groups. There was neither a difference in the number of unscheduled ambulatory visits nor in the number of readmissions.
  
  
  CONCLUSIONS
  Day-care continuous regional analgesia leads to an overall positive impact on costs by decreasing the incidence of unplanned ambulatory visits and unscheduled readmissions, without compromising on the quality of analgesia, patients' satisfaction, and safety.
authors.affiliation: Anaesthesiology Department, Bellinzona Regional Hospital, Bellinzona, Switzerland. andrea.saporito@eoc.ch.
authors.forename: Andrea
authors.initials: A
authors.lastname: Saporito
authors.affiliation: Mecop Institut, University of Italian Switzerland (USI), Lugano, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Calciolari
authors.affiliation: Mecop Institut, University of Italian Switzerland (USI), Lugano, Switzerland.
authors.forename: Laura Gonzalez
authors.initials: LG
authors.lastname: Ortiz
authors.affiliation: Anaesthesiology Department, Bellinzona Regional Hospital, Bellinzona, Switzerland.
authors.forename: Luciano
authors.initials: L
authors.lastname: Anselmi
authors.affiliation: Anaesthesiology Division, Balgrist University Hospital, Zurich, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Borgeat
authors.affiliation: Anaesthesiology Division, Balgrist University Hospital, Zurich, Switzerland.
authors.forename: José
authors.initials: J
authors.lastname: Aguirre
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics* / Q000379:methods; D000577:Amides / Q000008:administration & dosage / Q000191:economics; D000758:Anesthesia; D000765:Anesthesia, Conduction / Q000191:economics*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000191:economics; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005528:Foot / Q000601:surgery*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000191:economics* / Q000379:methods; D010045:Outpatients; D011787:Quality of Health Care; D012044:Regression Analysis; D000077212:Ropivacaine; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Continuous regional anesthesia; Foot surgery; Outpatient management