A long-term experience of day-case pelvic osteotomy for developmental dysplasia of the hip

TL;DR

This study shows that day-case pelvic osteotomy for hip dysplasia is safe, cost-effective, and reduces hospital bed demand over the long term.

Contribution

The paper presents a novel day-case pelvic osteotomy initiative and its long-term outcomes in a high-demand clinical setting.

Findings

Day-case pelvic osteotomies saved €3949 per patient compared to in-patient procedures.

The initiative reduced hospital bed demand while maintaining safety over 7 years.

110 day-case procedures resulted in total savings of €434,390 for the hospital.

Abstract

Developmental hip dysplasia has an incidence of 6.73 per 1000 live births and leads to a significant number of orthopaedic referrals annually. This high demand has encouraged the drive to optimize the efficiency of service provision in the paediatric orthopaedic setting. Here we describe our long-term experience with a novel day-case pelvic osteotomy initiative. We also describe any potential complications one can expect when performing day-case pelvic osteotomies.

This was a non-randomized prospective cohort study conducted to compare conventional in-patient pelvic osteotomies with day-case osteotomies performed between January 2017 and November 2023. All surgeries took place at an urban tertiary national referral centre by four paediatric orthopaedic surgeons with a specialist interest in DDH.

164 Salter and Pemberton osteotomies were performed of which 115 met the day-case criteria. Based on the HSE ‘Specialty Costing Report’ and ‘Annual Report and Financial Statements’, the total discharge cost for patients undergoing an in-patient osteotomy was €6619 in contrast to €2670 per day-case patient. For the 110 day-cases, the cost to treat amounted to €293,700; hence, there was a total saving of €434,390 made by the hospital for the 110 day-cases performed. This amounts to €3949 saved for every day-case.

Review at 7 years has demonstrated that day-case pelvic osteotomy surgery for DDH remains a safe and cost-effective initiative that significantly reduces the demand on in-patient hospital bed resources.

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