The use of specialized orthopedic nursing units (SONUs) for patients undergoing elective total hip arthroplasty (THA) is a well‐established practice. Whether such units improve outcomes or are cost effective has not been evaluated. Our study's aim was to determine the impact of SONUs on inpatient outcomes and resource utilization of patients undergoing elective THA.
We performed a retrospective cohort study using existing administrative and clinical databases. Patients undergoing elective THA between 1996 and 2004 at our institution who were admitted directly to a SONU were compared with those admitted to a nonorthopedic nursing unit (NONU) following surgery. In cases where electronic data were missing, manual abstraction and review of paper medical records were performed. Excluded from the cohort were patients who had an urgent, revision, or bilateral arthroplasty; whose primary diagnosis was trauma or septic arthritis; who were admitted a day or more prior to their surgical intervention; who were admitted directly to intensive care units following surgery; and who refused use of their records for research purposes. To determine differences between groups, a least‐squares means approach after adjustment for age, surgical year, Charlson comorbidity, and American Society of Anesthesiologists physical status was used.
There were 5546 patients who met the inclusion criteria, of whom 5275 (95.1%) were admitted to a SONU and 271 (4.9%) to a NONU. There was no difference in age or sex between groups. After adjustments, the total cost savings for the SONU patients were $622 ± $315 (95% CI: $3, $1241). With a current average of 60 patients admitted to nonorthopedic floors per year, such savings can amount to approximately $37,000 yearly. Adjusted hospital costs were decreased by $641 ± $296 (95% CI: $62, $1222) for patients cared for on a SONU. Blood bank and room and board costs were decreased by $110 ± $36 (95% CI: $40, $181) and $298 ± $118 (95% CI: $66, $530), respectively, for patients cared for on a SONU. There were no differences in physician or physical/occupational therapy costs. Adjusted length of stay was similar between groups, with a difference of 0.19 ± 0.11 days (95% CI: ‐0.02, 0.40 days). There were no differences in 30‐day outcomes or ICU utilization between groups.
Admission to specialty orthopedic nursing units following elective THA is associated with significant institutional cost savings, as well as reductions in transfusion costs, despite the absence of differences in 30‐day outcomes or length of stay. Our results suggest the need for a reevaluation of perioperative hospital flow in optimizing resource utilization among this group of patients.
J. A. Batsis, None; J. M. Naessens, None; M. T. Keegan, None; R. Trousdale, None; A. E. Wagie, None; J. M. Hud‐dleston, None.
To cite this abstract:Batsis J, Naessens J, Keegan M, Trousdale R, Wagie A, Huddleston J. Resource Utilization among Total Hip Arthroplasty Patients Cared for on Specialty Orthopedic Nursing Units. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 10. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/resource-utilization-among-total-hip-arthroplasty-patients-cared-for-on-specialty-orthopedic-nursing-units/. Accessed April 6, 2020.