Abstract
Introduction Outpatient procedures allow for an important cost reduction in high-prevalence procedures; however, patient safety must always be ensured.
Objective To evaluate the early complications and functional scores of patients undergoing an anterior cruciate ligament reconstruction (ACLR) as an outpatient procedure. An estimated cost reduction is also analyzed.
Materials and Methods A retrospective study of patients undergoing outpatient ACLR with a bone-patellar tendon-bone (BPTB) technique in one center between 2016 and 2018. Patients with less than one year of follow-up were excluded. All patients were submitted to the same anesthetic protocol: spinal anesthesia, a one-shot echo-guided adductor canal nerve block, and outpatient analgesics. Upon discharge, all patients received instructions regarding postoperative care, physical therapy exercises, and red flags. A telephone survey was conducted on the third day to evaluate the general conditions and complications, as well at the final follow-up, to collect pre- and postoperative Tegner and Lysholm functional scores. Patients who were not discharged on the same day, early non-scheduled visits, and re-interventions were recorded.
A cost-reduction analysis was performed for the inpatient versus outpatient procedures.
Results In total, 36 patients were submitted to an outpatient procedure, and 4 (11.1%) had an outside-in meniscal suture.
The survey was filled out by 23 patients (63.8%); all were in good general condition: 43% reported no pain and 57%, tolerable pain. No bleeding was observed.
The survey at the end of the follow-up (average: 22.5 ± 7.9 months) was filled out by 20 patients (55.5%); the scores on the Tegner and Lysholm scales improved significantly, from 3 (range: 1 to 6) to 6 (range: 3 to 8) (p = 0.0001), and from 44 (range: 12 to 81) to 91 (61 to 100) (p = 0.0001) respectively.
All patients were discharged on the same day of surgery.
There were 2 (5.5%) early visits, one due to a fall at home withdehiscence of the surgical wound, and one due to a non-complicated hematoma. Two re-interventions at the end of the follow-up were recorded: traumatic surgical-wound dehiscence and a patellar fracture.
The cost reduction for the outpatient procedure was of 203,205 pesos per patient
Conclusion The outpatient ACLR with the BPTB technique was a safe procedure in the present series, with adequate pain management and satisfactory functional scores at the medium-term follow-up. It was also associated with a reduction in cost estimates.
Keywords
anterior cruciate ligament - reconstruction - outpatient - complications - costs
