Elbow Surgery at a Community Hospital Saves Money

Abstract

Research Article| April 01 2020 Elbow Surgery at a Community Hospital Saves Money AAP Grand Rounds (2020) 43 (4): 47. https://doi.org/10.1542/gr.43-4-47 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Elbow Surgery at a Community Hospital Saves Money. AAP Grand Rounds April 2020; 43 (4): 47. https://doi.org/10.1542/gr.43-4-47 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: hospitals, community, money, operative procedure on elbow, fractures, orthopedics Source: Shasti M, Li TP, Case AL, et al. Cost analysis of treating pediatric supracondylar humerus fractures in community hospitals compared with a tertiary care hospital. J Am Acad Orthop Surg. 2019 10 July [published online ahead of print]; doi: https://doi.org/10.5435/JAAOS-D-18-00585Google Scholar Investigators at the University of Maryland and Johns Hopkins University, Baltimore, MD, conducted a retrospective cohort study to determine the costs of performing closed reduction per-cutaneous pinning (CRPP) of pediatric supracondylar humerus fractures (SCHFs) at a community hospital (CH) versus at a tertiary care hospital (TCH). Children <18 years who underwent CRPP for SCHF at the study institution between 2012 and 2016 were eligible. The study institution included a TCH and a system-associated CH. During the study period, 6 pediatric orthopaedic surgeons performed all CRPPs for SCHF at the study institution. Demographics for all eligible patients were obtained from the medical chart. The primary predictor was surgical location within the study institution, categorized as TCH or CH. The primary outcome was the fixed direct cost of health care delivery for the surgical encounter. Costs were obtained from the billing record and categorized as drug costs, operating room costs, imaging costs, routine costs (eg, charges for medical or surgical beds and admission charges), supplies, and other (eg, anesthesia). Investigators compared the outcome between TCH and CH locations. There were 133 participants included in the analysis. The mean age was 5.2 years, and 45% were female. Overall, 72% of surgeries were performed at the TCH. The cost of CRPP for SCHF at the TCH was $2,298.60 more than at the CH ($5,254.40 vs $2,955.80; P < .001). Costs were higher at the TCH (vs CH) in nearly all categories, including operating room costs ($3,350.10 vs $2,186.82; P < .001), other costs ($634.10 vs $205.73; P < .001), and imaging costs ($603.71 vs $242.72). Drug costs did not differ by surgical location. The authors conclude that CRPP for SCHF is cost saving when performed at a CH compared to a TCH. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Harvard health economist Michael Porter has written: value = outcomes/cost.1 Achieving high value for patients is one of the primary goals of health care delivery. The results of the current study in 133 children with displaced SCHFs for which surgery was indicated demonstrated that costs were 44% less (approximately $2,200), but yielded the same outcomes, thus suggesting increased value, when the child’s fracture was treated at a CH rather than if the child had been transferred from a CH to a TCH for the procedure. Decreased costs were ascribed primarily to operating room, anesthesia, and radiology-related savings. Pediatric SCHFs are the most commonly surgically treated fracture in children, and the treatment of these fractures is a basic Accreditation Council for Graduate Medical Education competency milestone for all orthopaedic surgeons.2 Pediatric SCHFs typically occur when a healthy... You do not currently have access to this content.