Research Paper Title

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

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. Therefore, the aim of this research was 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 $1,371 to $7,390. 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.

Conclusions

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.

Reference

Ferrari, D., Lopes, T.J., França, P.F., Azevedo, F.M. & Pappas, E. (2017) Outpatient versus inpatient anterior cruciate ligament reconstruction: A systematic review with meta-analysis. Knee. 24(2), pp.197-206. doi: 10.1016/j.knee.2017.01.002. Epub 2017 Jan 20.