title: Economic Analysis and Patient Satisfaction Associated With Outpatient Total Ankle Arthroplasty.
abstract: BACKGROUND
  Total ankle arthroplasty (TAA) is a rapidly growing treatment for end-stage ankle arthritis that is generally performed as an inpatient procedure. The feasibility of outpatient total ankle arthroplasty (OTAA) has not been reported in the literature. We sought to establish proof of concept for OTAA by comparing outpatient vs inpatient perioperative complications, postoperative emergency department (ED) visits, readmissions, patient satisfaction, and cost analysis.
  
  
  METHODS
  From July 2010 to September 2015, a total of 36 patients underwent TAA. Patients with prior ankle replacement, prior ankle infections, neuroarthropathy, or osteonecrosis of the talus were excluded from the study. All patient demographics, tourniquet times, estimated blood loss, comorbidities, concomitant procedures, complications, return ED visits, and readmissions were recorded. Patient satisfaction questionnaires were collected. Twenty-one patients had outpatient surgery and 15 had inpatient surgery. The cohorts were matched demographically.
  
  
  RESULTS
  The average length of stay for the inpatient group was 2.5 days. The overall cost differential between the groups was 13.4%, with the outpatient group being less costly. This correlates to a cost savings of nearly $2500 per case. One patient in the outpatient group had a return ED visit on postoperative day 1 for urinary retention. There were no 30-day readmissions in either group. Seventy-one percent of the outpatient group and 93% of the inpatient group would not change to a different postoperative admission status if they were to have the procedure again.
  
  
  CONCLUSIONS
  Our results show that OTAA was a cost-effective and safe alternative with low complication rates and high patient satisfaction. With proper patient selection, OTAA was beneficial to both the patient and the health care system by driving down total cost. It has the capacity to generate substantial savings while providing equal or better value to the patient.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: 1 Harvard Combined Orthopaedic Residency Program, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Gonzalez
authors.affiliation: 2 Harvard Medical School, Brigham Foot & Ankle Center, Faulkner Hospital, Boston, MA, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Fisk
authors.affiliation: 3 Orthopaedic Surgery, Harvard Medical School, Chief, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Brigham Foot and Ankle Center, Faulkner Hospital, Jamaica Plain, MA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chiodo
authors.affiliation: 2 Harvard Medical School, Brigham Foot & Ankle Center, Faulkner Hospital, Boston, MA, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Smith
authors.affiliation: 2 Harvard Medical School, Brigham Foot & Ankle Center, Faulkner Hospital, Boston, MA, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Bluman
mesh_terms: D000556:Ambulatory Surgical Procedures; D000843:Ankle Joint / Q000503:physiopathology* / Q000601:surgery; D058737:Arthroplasty, Replacement, Ankle / Q000379:methods*; D004467:Economics; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D010045:Outpatients; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies
keywords: ambulatory surgery; ankle arthritis; cost analysis; economic analysis; patient satisfaction; readmission; total ankle arthroplasty; total ankle replacement