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Outpatient versus inpatient anterior cruciate ligament reconstruction: A systematic review with meta-analysis

Journal Article


Abstract


  • Background Efforts to reduce the financial costs related to anterior cruciate ligament reconstruction (ACLR) include reducing the length of hospitalization of the patient undergoing ACLR. However, it is unclear if inpatient and outpatient ACLR differ in terms of safety, satisfaction, costs and clinical outcomes. Aim To systematically review and synthesize the literature that directly compared costs and outcomes after outpatient and inpatient ACLR. Methods Studies that directly compared outcomes of inpatient and outpatient ACLR were retrieved via searches in MEDLINE, EMBASE, CINAHL, AMED, Cochrane, SPORTDiscus, Web of Science and SCOPUS databases. Random effects meta-analysis and descriptive analysis were performed for relevant outcomes. Results Costs analysis suggests that outpatient ACLR may be a cost effective procedure with savings ranging from $1371 to $7390. There were no differences for systemic and local complications p��=��0.64 (odds ratio 1.65, 95% confidence interval 0.20 to 13.49) and p��=��0.72 (0.81, 0.26 to 2.56) respectively, or pain in the second and seventh days after surgery, p��=��0.78 (mean difference �����0.16; 95% confidence interval �����1.28 to 0.96) and p��=��0.44 (0.48, �����0.75 to 1.71), respectively. However, the outpatient group had less pain than the inpatient group in the first and third days after surgery, p��=��0.0001 (�����0.39, �����0.57 to �����0.21) and p��=��0.0001(�����0.39, �����0.39 to �����0.20), respectively. Descriptive analysis revealed that the outpatient group experienced similar or better satisfaction, strength and knee function compared to the inpatient group. Conclusion and key findings Complications, pain, satisfaction, knee function and strength are similar or better after outpatient compared to inpatient ACLR. Furthermore, cost savings may be achieved with outpatient ACLR. However, included studies presented low methodological quality and the quality of evidence was very low, so these results need to be confirmed by future studies. Registration number PROSPERO (CRD42015024990).

Publication Date


  • 2017

Published In


Citation


  • Ferrari, D., Lopes, T. J. A., Fran��a, P. F. A., Azevedo, F. M., & Pappas, E. (2017). Outpatient versus inpatient anterior cruciate ligament reconstruction: A systematic review with meta-analysis. Knee, 24(2), 197-206. doi:10.1016/j.knee.2017.01.002

Scopus Eid


  • 2-s2.0-85009918602

Start Page


  • 197

End Page


  • 206

Volume


  • 24

Issue


  • 2

Place Of Publication


Abstract


  • Background Efforts to reduce the financial costs related to anterior cruciate ligament reconstruction (ACLR) include reducing the length of hospitalization of the patient undergoing ACLR. However, it is unclear if inpatient and outpatient ACLR differ in terms of safety, satisfaction, costs and clinical outcomes. Aim To systematically review and synthesize the literature that directly compared costs and outcomes after outpatient and inpatient ACLR. Methods Studies that directly compared outcomes of inpatient and outpatient ACLR were retrieved via searches in MEDLINE, EMBASE, CINAHL, AMED, Cochrane, SPORTDiscus, Web of Science and SCOPUS databases. Random effects meta-analysis and descriptive analysis were performed for relevant outcomes. Results Costs analysis suggests that outpatient ACLR may be a cost effective procedure with savings ranging from $1371 to $7390. There were no differences for systemic and local complications p��=��0.64 (odds ratio 1.65, 95% confidence interval 0.20 to 13.49) and p��=��0.72 (0.81, 0.26 to 2.56) respectively, or pain in the second and seventh days after surgery, p��=��0.78 (mean difference �����0.16; 95% confidence interval �����1.28 to 0.96) and p��=��0.44 (0.48, �����0.75 to 1.71), respectively. However, the outpatient group had less pain than the inpatient group in the first and third days after surgery, p��=��0.0001 (�����0.39, �����0.57 to �����0.21) and p��=��0.0001(�����0.39, �����0.39 to �����0.20), respectively. Descriptive analysis revealed that the outpatient group experienced similar or better satisfaction, strength and knee function compared to the inpatient group. Conclusion and key findings Complications, pain, satisfaction, knee function and strength are similar or better after outpatient compared to inpatient ACLR. Furthermore, cost savings may be achieved with outpatient ACLR. However, included studies presented low methodological quality and the quality of evidence was very low, so these results need to be confirmed by future studies. Registration number PROSPERO (CRD42015024990).

Publication Date


  • 2017

Published In


Citation


  • Ferrari, D., Lopes, T. J. A., Fran��a, P. F. A., Azevedo, F. M., & Pappas, E. (2017). Outpatient versus inpatient anterior cruciate ligament reconstruction: A systematic review with meta-analysis. Knee, 24(2), 197-206. doi:10.1016/j.knee.2017.01.002

Scopus Eid


  • 2-s2.0-85009918602

Start Page


  • 197

End Page


  • 206

Volume


  • 24

Issue


  • 2

Place Of Publication