title: Outpatient versus inpatient anterior cruciate ligament reconstruction: A systematic review with meta-analysis.
abstract: BACKGROUND
  Efforts to reduce the financial costs related to anterior cruciate ligament reconstruction (ACLR) include reducing the length of hospitalization of the patient undergoing ACLR. However, it is unclear if inpatient and outpatient ACLR differ in terms of safety, satisfaction, costs and clinical outcomes.
  
  
  OBJECTIVE
  To systematically review and synthesize the literature that directly compared costs and outcomes after outpatient and inpatient ACLR.
  
  
  METHODS
  Studies that directly compared outcomes of inpatient and outpatient ACLR were retrieved via searches in MEDLINE, EMBASE, CINAHL, AMED, Cochrane, SPORTDiscus, Web of Science and SCOPUS databases. Random effects meta-analysis and descriptive analysis were performed for relevant outcomes.
  
  
  RESULTS
  Costs analysis suggests that outpatient ACLR may be a cost effective procedure with savings ranging from $1371 to $7390. There were no differences for systemic and local complications p=0.64 (odds ratio 1.65, 95% confidence interval 0.20 to 13.49) and p=0.72 (0.81, 0.26 to 2.56) respectively, or pain in the second and seventh days after surgery, p=0.78 (mean difference -0.16; 95% confidence interval -1.28 to 0.96) and p=0.44 (0.48, -0.75 to 1.71), respectively. However, the outpatient group had less pain than the inpatient group in the first and third days after surgery, p=0.0001 (-0.39, -0.57 to -0.21) and p=0.0001(-0.39, -0.39 to -0.20), respectively. Descriptive analysis revealed that the outpatient group experienced similar or better satisfaction, strength and knee function compared to the inpatient group.
  Complications, pain, satisfaction, knee function and strength are similar or better after outpatient compared to inpatient ACLR. Furthermore, cost savings may be achieved with outpatient ACLR. However, included studies presented low methodological quality and the quality of evidence was very low, so these results need to be confirmed by future studies.
  
  
  BACKGROUND
  PROSPERO (CRD42015024990).
authors.affiliation: University of São Paulo, Post-Graduation Program Interunits Bioengineering EESC/FMRP/IQSC-USP, São Carlos, Brazil; CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70.040-020, Brazil. Electronic address: deisiferrari@hotmail.com.
authors.forename: Deisi
authors.initials: D
authors.lastname: Ferrari
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Research Laboratory of Exercise Science, The Brazilian Navy, Rio de Janeiro, Brazil. Electronic address: tjam7956@uni.sydney.edu.au.
authors.forename: Thiago J A
authors.initials: TJA
authors.lastname: Lopes
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia. Electronic address: paulofernando82@hotmail.com.
authors.forename: Paulo F A
authors.initials: PFA
authors.lastname: França
authors.affiliation: University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil. Electronic address: micolis@uol.com.br.
authors.forename: Fábio M
authors.initials: FM
authors.lastname: Azevedo
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia. Electronic address: evangelos.pappas@sydney.edu.au.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Pappas
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics*; D059549:Anterior Cruciate Ligament Reconstruction / Q000191:economics*; D003362:Cost-Benefit Analysis; D006760:Hospitalization / Q000191:economics*; D006801:Humans
keywords: ACL; Ambulatory; Complications; Day-case; Safety