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Wednesday, March 15, 2000

ACLR can be performed in outpatient facility

Anterior cruciate ligament reconstruction (ACLR) using bone-tendon-bone autograft with or without meniscal repair or debridement can be performed in an outpatient surgical facility safely and effectively with a significantly reduced charge to the patient, say researchers of a study in poster exhibit 8.

They prospectively followed 300 consecutive patients who underwent the aforementioned procedures from 1994 to 1998. Exclusionary criteria included ACLR with hamstring or allograft, multiligament reconstruction and revision operations. The patients were divided into three groups: ACLR alone, ACLR plus meniscal repair and ACLR plus subtotal meniscectomy. All patients were evaluated at specific time intervals postoperatively. The facility charges to the patient, reoperation rate, infection rate, adequacy of pain management and number of emergency room visits required postoperatively were evaluated.

The average charge to all patients from May 1994 to August 1998 was $3,544. Four (1.3 percent) patients required a second operation for a symptomatic knee flexion contracture. Two patients (0.7 percent) developed a superficial wound infection that resolved with oral antibiotics. Visual analog pain scores peaked at 6.3 on the first day postoperative and steadily declined over the next seven days. One patient (0.3 percent) required an emergency room visit for inadequate pain control. Two patients (0.7 percent) received intravenous fluids in the outpatient surgical facility for dehydration secondary to nausea/vomiting. No patients required hospital admission.

The researchers said the charges to this patient population were found to be significantly reduced when compared to a previously studied cohort undergoing the same procedures in the main hospital ($3,536 versus $12,382). The rate of reoperation was similar between the two groups (1.3 percent vs. 5 percent). Although three patients required reevaluation postoperatively for inadequate pain management or dehydration none required admission into the hospital

"These results indicate that outpatient ACLR can be safely performed with a reduced patient charge," said Barnard R. Bach Jr., MD, professor, orthopaedic surgery; director, sports medicine section; department of orthopaedic surgery, Rush Medical College. Others who participated in the study are Andrew Curran, MD, orthopaedic resident; Andrew E. park, MD, orthopaedic resident; Stephen Yao, MD, medical student; and Charles A. Bush-Joseph, MD, associate professor.

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2000 Academy News March 15 Index B

Last modified 06/March/2000 by IS