title: Functional outcome and cost-effectiveness of outpatient vs inpatient care for complex hind-foot and ankle surgery. A retrospective cohort study.
abstract: OBJECTIVE
  To compare the postoperative functional outcome and the total cost associated with outpatient vs inpatient care following complex hind-foot and ankle surgery.
  
  
  METHODS
  Retrospective, cohort study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Forty patients, American Society of Anesthesiologists 1-3, of either sex undergoing elective complex hind-foot and ankle surgery (fusion, osteotomy, or multiple ligament repair).
  
  
  METHODS
  Both inpatients and outpatients received a continuous perineural infusion of local anesthetic for 48 hours at the core of a multimodal analgesic regimen. Patients were retrospectively identified, and an outpatient cohort was matched to an inpatient cohort in a 1:1 ratio for age, sex, baseline functional score, and type of surgery.
  
  
  METHODS
  The primary outcome was functional outcome upon discharge of the surgical program as measured by the Lower Extremity Functional Score. Secondary outcomes were the incidence of surgical or anesthetic complications and the total perioperative cost of care.
  
  
  RESULTS
  Patients in both cohorts had similar functional outcome on discharge of the surgical program. Analgesia was effective in both groups, and no complications were reported. The cost of care for outpatients was 54% lower than that for inpatients.
  
  
  CONCLUSIONS
  This retrospective study suggests that outpatient care including an ambulatory perineural infusion of local anesthetic may be a cost-effective alternative to inpatient care after complex foot and ankle surgery.
authors.affiliation: University of Toronto. Electronic address: Jmo77@cornell.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Oh
authors.affiliation: Department of Anesthesia and Pain Management, Toronto Western Hospital; Department of Anesthesia, University of Toronto. Electronic address: Anahi.perlas@uhn.ca.
authors.forename: Anahi
authors.initials: A
authors.lastname: Perlas
authors.affiliation: Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital; Department of Surgery, University of Toronto. Electronic address: Johnny.lau@uhn.ca.
authors.forename: Johnny
authors.initials: J
authors.lastname: Lau
authors.affiliation: Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital; Department of Surgery, University of Toronto. Electronic address: Rajiv.gandhi@uhn.ca.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gandhi
authors.affiliation: Department of Anesthesia and Pain Management, Toronto Western Hospital; Department of Anesthesia, University of Toronto. Electronic address: Vincent.chan@uhn.ca.
authors.forename: Vincent W S
authors.initials: VW
authors.lastname: Chan
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000779:Anesthetics, Local / Q000008:administration & dosage; D000842:Ankle / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006365:Heel / Q000601:surgery*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000191:economics*; D019990:Perioperative Care / Q000191:economics; D011183:Postoperative Complications; D012189:Retrospective Studies; D012584:Sciatic Nerve / Q000187:drug effects; D062606:Tertiary Care Centers / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local
keywords: Complex foot and ankle surgery; Cost-effectiveness; Functional outcome; Outpatient care