title: Cost savings of outpatient versus standard inpatient total knee arthroplasty.
abstract: BACKGROUND
  With diminishing reimbursement rates and strained public payer budgets, a high-volume inpatient procedure, such as total knee arthroplasty (TKA), is a common target for improving cost efficiencies.
  
  
  METHODS
  This prospective case-control study compared the cost-minimization of same day discharge (SDD) versus inpatient TKA. We examined if and where cost savings can be realized and the magnitude of savings that can be achieved without compromising quality of care. Outcome variables, including detailed case costs, return to hospital rates and complications, were documented and compared between the first 20 SDD cases and 20 matched inpatient controls.
  
  
  RESULTS
  In every case-control match, the SDD TKA was less costly than the inpatient procedure and yielded a median cost savings of approximately 30%. The savings came primarily from costs associated with the inpatient encounter, such as surgical ward, pharmacy and patient meal costs. At 1 year, there were no major complications and no return to hospital or readmission encounters for either group.
  
  
  CONCLUSIONS
  Our results are consistent with previously published data on the cost savings associated with short stay or outpatient TKA. We have gone further by documenting where those savings were in a matched cohort design. Furthermore, we determined where cost savings could be realized during the patient encounter and to what degree. In carefully selected patients, outpatient TKA is a feasible alternative to traditional inpatient TKA and is significantly less costly. Furthermore, it was deemed to be safe in the perioperative period.
authors.affiliation: All authors are from the Division of Orthopaedic Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, Ont.
authors.forename: Adrian
authors.initials: A
authors.lastname: Huang
authors.affiliation: All authors are from the Division of Orthopaedic Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, Ont.
authors.forename: Jae-Jin
authors.initials: JJ
authors.lastname: Ryu
authors.affiliation: All authors are from the Division of Orthopaedic Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, Ont.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dervin
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D016022:Case-Control Studies; D017046:Cost Savings / Q000191:economics*; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D011446:Prospective Studies