Yoeri Bemelmans

Chapter 7 112 PROMs Seven studies reported a comparison of postoperative improvements in PROMs between outpatient and inpatient pathways [25, 26, 29, 36,37,38, 48]. Used PROMs varied and included the Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5D (EQ-5D), Visual Analogue Scale (VAS) for pain, and patient satisfaction questionnaires. The postoperative improvement was similar between outpatient pathways and inpatient pathways for all PROMs. The follow- up period ranged from 30 days to 1 year. High patient satisfaction was reported in three studies for OJA and inpatient pathways [26, 38, 48]. Two studies (one in an ambulatory surgical center and one in a hip/knee center) [26, 38] reported favorable outcomes on patient satisfaction. Patient satisfaction was either measured with a numerical scale [48] or with the use of a survey by telephone [26, 38]. Costs Seven observational studies reported on costs [5, 6, 28, 35, 41, 42, 52]. Evaluation and description of costs varied highly across studies. Six of seven studies (86%) reporting on costs were conducted in the United States. Only total costs were compared between outpatient and inpatient pathways. Amean (SD) cost reduction of $6.797,02 ($5.394,81) was found in favor of outpatient pathways, but with a large range ($2.468,62-$20.573,00). Overall, usage of surgery (e.g. surgery facility fee, operation room supplies) and hospital facility (e.g. nursing, room charges, laboratory tests, medication, perioperative physiotherapy) contributed the most in the cost reduction.