COST EFFICIENCY OF DAY-CASE HIP AND KNEE ARTHROPLASTY: SINGLE-CENTRE COST ANALYSIS

Outpatient (day-case) arthroplasties gained popularity in recent years as a possible solution to tackle increasing waiting lists for elective hip replacement. There is an good evidence that such pathways result in improved patient outcomes with reduced post-operative complications and increased patient satisfaction. However, there is a remaining question whether day-case pathways are financially feasible for the trusts. The primary objective of this study is to establish whether the elective outpatient hip arthroplasty is more cost-efficient as compared to an inpatient procedure. The secondary outcomes include identification of the components of patient stay that contributed to the biggest differences in cost. In this single centre study, we analysed a cohort of patients that underwent an elective total hip arthroplasty between March 2022 and December 2022. Within this period 61 underwent a primary total hybrid hip replacement (54 inpatients, 7 outpatients). The inpatient and outpatient cases were then matched based on their age, type of procedure, and significant comorbidities. The cost per procedure with associated peri-operative care was then compared between the matched cohorts. Further comparison of individual components contributing to the total price, such as physiotherapy or ward stay, has been made. On average the total cost of outpatient arthroplasty has been found to be 51/9% lower than a corresponding inpatient surgery. That translates to savings of over £4,500 per average procedure. The main contributing costs, the medical/surgical teams and ward stay per patient, were reduced by £1,113 and £903 (47.4% and 71.8%) respectively. A significant cost reduction (52.4%) was also observed within the therapy sector. The only sector which turned out more expensive for the outpatient cohort was the pharmacy with additional £130 per patient (increase by 144%). In conclusion, this study provides evidence that outpatient hip arthroplasties are not only a cost effective solution, but also allow to reduce the cost of the procedure to below the national tariff. Therefore, they can be an attractive option for the NHS trust, as a mean of cost reduction while maintaining excellent patient outcomes.