SLR - June 2011 - Jonathan L. Brown (2)
Reference: Goel, D; Chan, D; Watson, K; Mohtadi, N. (2009). Safety and hospital costs of Achilles tendon surgery: the serendipitous impact of a randomized clinical trial. Canadian Journal of Surgery, 52(6).
Scientific Literature Review
Reviewed by: Jonathan L. Brown, DPM
Residency Program: DVA San Francisco
Podiatric Relevance:
Achilles tendon rupture is a common pathology treated by podiatrists. There is little literature suggesting whether inpatient versus outpatient therapy is superior, not in just patient performance, but in cost comparison.
Methods:
This study is an observational analytical retrospective chart review of all patients surgically treated for acute Achilles tendon ruptures at all Calgary-area hospitals over a 3-year period. The two populations of patients examined in this study were between a group enrolled in a Multicenter Achilles Tendon Treatment Study (MATTS) treated as outpatients compared to the general population with a standard of care consisting of diagnosis confirmation, orthopedic referral, and admittance for surgery. Patients were analyzed across groups according to length of hospital stay and the related costs’ acquired.
Results:
Two hundred eighty-two charts were analyzed, with 33 patients in the MATTS group and 249 in the non-MATTS group. The majority of the MATTS patients (27 of 33; 82%) had same-day surgery, while only 5 of 33 (15.2%) stayed overnight in the hospital. Only 1 patient (3%) stayed 2 days. Of the non-MATTS group, only 11% (27 of 249) had same-day surgery, whereas the majority (95 of 249; 38%) stayed for 1 night and 5% (12 of 249) stayed 2 nights. In the MATTS group, the average cost per patient for a same-day surgery was $682, and the average for an overnight stay was $1237. The average same-day surgery cost per patient in the non-MATTS group was $669 and the $1709 for 1 or more nights.
Conclusions:
Rupture of the Achilles tendon is a common injury that is frequently treated with surgical repair. This study concludes that surgical treatment of Achilles ruptures is both safe and less costly when performed on an outpatient basis.