Clinical implications and costs of in-hospital versus outpatient orthopedic surgeries

Objective: This article reviews clinical implications and costs associated with orthopedic surgeries performed in inpatient versusoutpatient settings. Methods: Studies spanning the publication period between 2000 and 2023 were included, exploring a variety of study designs. Results: Results indicate that outpatient surgeries are associated with lower rates of postoperative complications, shorter recovery times, and greater patient satisfaction, as well as with significantly lower direct and indirect costs. Analysis of postoperative complications suggests that factors such as the home recovery environment and early mobilization may contribute to improved clinical outcomes, corroborating existing literature on the safety and efficacy of outpatient surgeries. Faster recovery after outpatient surgeries was consistently observed, with patients returning to normal activities an average of two weeks earlier compared with those undergoing inpatient surgeries. The greater patient satisfaction with outpatient surgeries reflects the convenience of avoiding hospitalization, with less disruption to daily life and reduced anxiety associated with the hospital environment. In economic terms, outpatient surgeries have been shown to be a financially advantageous alternative, with reduced direct costs due to the lower hospital fees and nursing services required, as well as lower indirect costs due to reduced productivity loss and transportation expenses. Conclusion: Findings are particularly relevant in a context of increasing pressure to contain spending in the health system. Level of Evidence I; Systematic review of level I studies.