Medical economic study of outpatient versus inpatient surgical management of distal radius fractures

Introduction: France aims to have more than 70% of its surgical procedures performed in an outpatient setting by 2022.

Hypothesis: The primary hypothesis of this study was that outpatient management of distal radius fractures with volar plating was more cost-effective than inpatient hospitalization. The secondary hypothesis was that more than 70% of these cases could be managed in an outpatient setting.

Materials and methods: The series included 255 fractures that were operated on between February 2015 and February 2016. These were reviewed using 4 patient-specific criteria (age, ASA score, eligibility for an outpatient procedure, and anticoagulant therapy) and 4 injury-specific criteria (AO classification, open wound, nerve involvement, and other locations). Our outpatient rate was compared to the national rate and the net income was calculated according to the length of stay.

Results: Our series reported an outpatient rate of 77.25% with a mean age of 54years (19/95) and an inpatient rate of 22.75% with a mean age of 74 years (30/94). The national rate in 2018 was 34.8%. While outpatient procedures generated an operating profit of +€191.64, hospitalizations of 1 to 17 nights resulted in an operating loss. The overall economic assessment of the 255 fractures included in our series showed an operating loss of €22,113.78.

Discussion: Our primary hypothesis was confirmed since the outpatient management of distal radius fractures was more cost-effective than inpatient hospitalization. The secondary hypothesis was also confirmed since more than 70% of cases in our series were treated in an outpatient setting.

Conclusion: Most distal radius fractures requiring a surgical intervention should be treated in an outpatient setting.

Level of evidence: IV.