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

Deisi Ferrari; Thiago J A Lopes; Paulo F A França; Fábio M Azevedo; Evangelos Pappas

doi:10.1016/j.knee.2017.01.002

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

Knee. 2017 Mar;24(2):197-206. doi: 10.1016/j.knee.2017.01.002. Epub 2017 Jan 20.

Authors

Deisi Ferrari¹, Thiago J A Lopes², Paulo F A França³, Fábio M Azevedo⁴, Evangelos Pappas⁵

Affiliations

¹ University of São Paulo, Post-Graduation Program Interunits Bioengineering EESC/FMRP/IQSC-USP, São Carlos, Brazil; CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70.040-020, Brazil. Electronic address: deisiferrari@hotmail.com.
² Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Research Laboratory of Exercise Science, The Brazilian Navy, Rio de Janeiro, Brazil. Electronic address: tjam7956@uni.sydney.edu.au.
³ Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia. Electronic address: paulofernando82@hotmail.com.
⁴ University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil. Electronic address: micolis@uol.com.br.
⁵ Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia. Electronic address: evangelos.pappas@sydney.edu.au.

PMID: 28117216
DOI: 10.1016/j.knee.2017.01.002

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).

Keywords: ACL; Ambulatory; Complications; Day-case; Safety.

Publication types

Comparative Study
Meta-Analysis
Review
Systematic Review

MeSH terms

Ambulatory Surgical Procedures / economics*
Anterior Cruciate Ligament Reconstruction / economics*
Cost-Benefit Analysis
Hospitalization / economics*
Humans