Surgical Treatment of Pediatric Foot and Ankle Fractures in a Freestanding Ambulatory Surgery Center is a Safe, Cost-effective Alternative to a Hospital

Stephanie Chen; Jordan Ritchie; Jacob Hernandez; Nyma Khan; Vikki Nolan; Benjamin W Sheffer; Derek M Kelly

doi:10.1097/BPO.0000000000002854

Surgical Treatment of Pediatric Foot and Ankle Fractures in a Freestanding Ambulatory Surgery Center is a Safe, Cost-effective Alternative to a Hospital

J Pediatr Orthop. 2024 Oct 29. doi: 10.1097/BPO.0000000000002854. Online ahead of print.

Authors

Stephanie Chen¹, Jordan Ritchie², Jacob Hernandez³, Nyma Khan⁴, Vikki Nolan⁵, Benjamin W Sheffer¹, Derek M Kelly¹

Affiliations

¹ Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center.
² Medical University of South Carolina, Charleston, SC.
³ College of Medicine, University of Tennessee Health Science Center.
⁴ School of Public Health, University of Memphis.
⁵ Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.

PMID: 39467846
DOI: 10.1097/BPO.0000000000002854

Abstract

Background: In the United States, the number of pediatric fractures treated in ambulatory surgery centers (ASCs) continues to increase. Few studies have compared the outcomes and complications of treating these injuries in a freestanding ASC versus in a hospital setting. The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of pediatric foot and ankle fractures in the ASC and hospital.

Methods: A retrospective review identified pediatric patients with isolated, closed, and acute (below 3 wk) distal tibia, ankle, or foot fractures who underwent closed reduction in an operating room or operative fixation between January 2015 and December 2019. The patients were divided into 2 groups: ASC and hospital. Medical records were reviewed for patient demographics, mechanism of injury, surgical time, facility time, costs for treatment, and complications. Preoperative and postoperative alignment was assessed on radiographs. Clinical outcomes included pain, weight-bearing, or deformity at final follow-up. Multivariable generalized linear models and logistic regression were used to determine the association between surgical setting and treatment outcomes, times, and costs.

Results: Two hundred and twenty-three patients were identified; 115 treated in the ASC and 108 treated in the hospital. Adjusted for age at treatment, injury type, procedure performed, and preoperative alignment, there were no differences in surgical time, clinical or radiographic outcomes, or complications between groups. The mean total operating room time, total facility time, and total charges were significantly lower in patients treated in the ASC than in the hospital.

Conclusion: Pediatric distal tibia, ankle, and foot fractures can be safely treated in an ASC with equivalent outcomes and complications compared with those in a hospital setting. Benefits include shorter total surgical and facility times as well as decreased cost of care. These findings could allow for patients to receive more timely and efficient treatment with less financial burden.

Level of evidence: Level III-therapeutic.