Safety and Satisfaction of Outpatient Versus Inpatient Care for Arthroscopic Knee Surgery in Thailand

Background: Although outpatient surgery volume has rapidly grown in the western counties. However, the rate of growth for outpatient surgery has been slow in Thailand. There are limited studies comparing outcomes and cost analysis in outpatient arthroscopic knee surgery in Thailand. Objective: To compare the 24-hour postoperative pain score, side-effects and the total cost associated between inpatient and outpatient care following arthroscopic knee surgery. Materials and Methods: A retrospective cohort study of 42 patients undergoing elective arthroscopic knee surgery under general anesthesia and receiving ultrasound guided adductor canal block for post-operative analgesia. The two cohorts were matched with a 1:1 ratio for age, sex, body mass index, type of surgery and operation time. The primary outcome was the 24-hour postoperative pain score. Secondary outcomes included: the incidence of inadequate analgesia, adverse events, cost associated with outpatient versus inpatient care, and patient satisfaction score. Results: The 24-hour postoperative pain score was median 2 (IQR 0, 3) versus 2 (IQR 1, 3) in the outpatient and inpatient groups, respectively. No major complications, reoperation, or readmission after surgery was seen in either group. The total hospital cost between outpatient versus inpatient showed not significant difference (1,871.09±555.53 USD versus 1,966.49±549.70 USD, p=0.58). The costs related to perioperative service, inpatient surgery ward service, and room and food service were significantly different. Satisfaction score was comparable between groups. Conclusion: In Thailand, outpatient arthroscopic knee surgery provided the same 24-hour postoperative pain control scores and clinical outcomes when compared to inpatient setting. There was no significant difference in total hospital cost between outpatient and inpatient care. However, costs related to perioperative period (e.g., inpatient room and food service) were significantly different. Keywords: Ambulatory surgery; Arthroscopic knee surgery; Adductor canal block; Safety and satisfaction; Medical cost