CME OnDemand: 2022 AOFAS Annual Meeting-Cost Efficiency of Ankle Fracture ORIF at an Ambulatory Surgical Center vs Hospital

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The study evaluated the cost and efficiency differences of ankle fracture open reduction and internal fixation (ORIF) at an outpatient ambulatory surgical center (ASC) versus a hospital setting. The researchers used Time-Driven Activity Based Costing (TD-ABC), a novel accounting method, to accurately assign costs for the procedures. A prospective cohort study was conducted, involving four orthopaedic surgeons and patients with uni-, bi-, or tri-malleolar displaced ankle fractures undergoing ORIF.<br /><br />Overall, the total direct cost was found to be similar between the ASC and hospital. However, certain direct costs were significantly higher in the hospital, including perioperative/anesthesia, pharmacy, radiology, and therapy. Medical supply costs, including implant costs, were significantly higher at the ASC.<br /><br />Times for various steps of care were shorter in the hospital setting compared to the ASC. Preoperatively, nurse assessment of the patient was quicker in the hospital, while patient transport to the operating room was faster in the ASC. Case duration was longer in the ASC, potentially influenced by case complexity.<br /><br />The study concluded that direct costs appeared to be lower at the ASC, while efficiency of care delivery appeared similar between the two settings. Areas for potential improvement were identified, including preoperative nurse assessment of the patient and the efficacy of regional nerve block administration.<br /><br />The researchers suggested that larger studies implementing TD-ABC would be needed to further investigate these findings. The study acknowledged the need for more research in this area to provide a better understanding of the cost efficiency of ankle fracture ORIF at ASCs versus hospitals.

Asset Subtitle

John R. Allen, Caroline P. Hoch, Christopher E. Gross, Daniel J. Scott, MD, MBA

Keywords

ankle fracture

open reduction and internal fixation

ORIF

outpatient ambulatory surgical center

ASC

hospital setting

Time-Driven Activity Based Costing

TD-ABC

direct costs

efficiency of care delivery