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Lippincott, Williams & Wilkins, Anesthesiology, 6(123), p. 1256-1266, 2015

DOI: 10.1097/aln.0000000000000852

Lippincott, Williams & Wilkins, Survey of Anesthesiology, 3(60), p. 93, 2016

DOI: 10.1097/sa.0000000000000217

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An Expedited Care Pathway With Ambulatory Brachial Plexus Analgesia Is a Cost-effective Alternative to Standard Inpatient Care After Complex Arthroscopic Elbow Surgery:

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This paper was not found in any repository, but could be made available legally by the author.

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Abstract

AbstractBackgroundCommon standard practice after complex arthroscopic elbow surgery includes hospital admission for 72 h. The authors hypothesized that an expedited care pathway, with 24 h of hospital admission and ambulatory brachial plexus analgesia and continuous passive motion at home, results in equivalent elbow range of motion (ROM) 2 weeks after surgery compared with standard 72-h hospital admission.MethodsA randomized, single-blinded study was conducted after obtaining approval from the research ethics board. Forty patients were randomized in a 1:1 ratio using a computer-generated list of random numbers into an expedited care pathway group (24-h admission) and a control group (72-h admission). They were treated equally aside from the predetermined hospital length of stay.ResultsPatients in the control (n = 19) and expedited care pathway (n = 19) groups achieved similar elbow ROM 2 weeks (119 ± 18 degrees and 121 ± 15 degrees, P = 0.627) and 3 months (130 ± 18 vs. 130 ± 11 degrees, P = 0.897) postoperatively. The mean difference in elbow ROM at 2 weeks was 2.6 degrees (95% CI, −8.3 to 13.5). There were no differences in analgesic outcomes, physical function scores, and patient satisfaction up to 3 months postoperatively. Total hospital cost of care was 15% lower in the expedited care pathway group.ConclusionThe results suggest that an expedited care pathway with early hospital discharge followed by ambulatory brachial plexus analgesia and continuous passive motion at home is a cost-effective alternative to 72 h of hospital admission after complex arthroscopic elbow surgery.