All right, so my name is Mike Galea from NYU. Thanks to the selection committee for including this in the talks. Our disclosures can be found on the AOS website. So a brief introduction. Obviously, everybody in here knows that neosteotomies are becoming increasingly more and more popular, whether it be for cartilage, instability, et cetera. But with that comes concerns, whether it be pain control that requires admission or vascular complications, management of intraoperative complications such as fracture, et cetera. So patients may often be kept in-house for observation over overnight or for one or two days depending on where you are and who you speak to. But with that comes an increasing demand for safe, high-quality care with an emphasis on value, especially in the United States. There's increased interest in the feasibility and the safety of outpatient procedures, and the literature has really demonstrated feasibility and safety in outpatient replacements, whether it be shoulder, knee, hip, et cetera. So the purpose of this study is to rate the, to assess the rate of inpatient conversions, hospital readmissions, reoperations, and complications with all sorts of the osteotomies around the knee performed at an ambulatory surgery center compared to that of an inpatient hospital facility. So the methods, this is an IRB-approved retrospective comparative study. Osteotomies were either performed at an ambulatory surgery center versus an inpatient hospital facility. The minimum was 90 days of follow-up for this cohort. Exclusion criteria included BMI over 40, ASA 3 and above. Patients undergoing concomitant procedures, whether that be ligamentous reconstruction, cartilage restoration, were included in this study. Nerve blocks were judiciously used for HTOs and TTOs. DFOs really, in our cases, did not get nerve block anesthesia. So for us, the primary outcome in this was immediate conversion for any reason from an ASC to an in-hospital stay, whether that be for pain control, neurovascular monitoring, complications, et cetera. The secondary outcomes include intraoperative or postoperative complications, readmissions, and secondary procedures that were unplanned within 90 days of the initial surgery. Statistical analysis was then performed. Now moving into our results, we had a cohort of about seven years' worth, encompassing about 530 osteotomies that met our criteria. Two hundred and twenty-two of these were performed at our ASC for a total of 41.8%. None of our patients were lost to follow-up. If you look at the patient demographics, the ages were relatively similar, 33 years old, 32. BMI was pretty much similar. ASA was similar, usually one or two. And the ratios of DFO, HTO, and TTO were roughly equivalent as well. DFO is obviously the most rare procedures that we did in terms of our osteotomies. So our initial outcome, and you can see on the bottom in red, is that no patient in our ASC cohort required an immediate inpatient conversion for pain control or perioperative complications. So of those 222 patients that were done at the outpatient surgery facility, we did not have to admit any of them overnight for pain control, et cetera. We also found no differences in complications, whether that be perioperatively, postoperatively, readmissions. We did find that wound complications were the most common complication that we had, about 2 or 3% in both cohort. But there were no differences when comparing ASC to our inpatient hospital. That being said, when we look at our hospital-setting patients, only 41% of them were discharged on postoperative day zero. That meant that 60% of those patients that were having their osteotomies done at our surgery, at our actual hospital facility, they were offered the choice to stay or leave, and 60% of them actually stayed. Now the problem with that is that we found that the average stay was almost two days. So patients that got admitted overnight, whether it be for pain control, et cetera, may not clear physical therapy, and they wind up having an overnight stay turn into something a little bit longer. We also found no differences in any of our 90-day complications for any of the parameters, whether that be arthrofibrosis, DVT, infection, painful hardware, et cetera. Really no differences in our cohorts. So moving on to our limitations, obviously this is a non-randomized retrospective study. It's inherent selection bias with this. We did include all of our neo-osteotomies. They weren't just TTO or DFO, et cetera. Again it could be a possible falsely elevated result from our hospital setting, because again, you know, there's two reasons. Number one, patients could have just elected to stay, or number two, and I know this from myself and from my other partners on this study, Dr. Strauss, Dr. Jezraoui, early on in our practices we were a little bit more hesitant to do these in an outpatient facility because we simply didn't know what their pain tolerance was going to be like. We didn't know whether it would be safe or whatnot. So we might have been selectively choosing to do those patients at the hospital center. So you know, obviously things have changed, and we want to feel much more comfortable doing this at the ASC. We had multiple surgeons in the cohort, which some might say is a limitation. Some might say it's a strength. We did have varying ranges of surgeon expertise in this, from 20, 25 years experience to about one or two years of experience, which potentially could mitigate that. So in our conclusions we did find that performing knee osteotomies at an outpatient surgery center have similar complication profiles at 90 days, similar readmission rates at 90 days, and an extremely low conversion rate to an inpatient stay. It was zero in our cohort. Now obviously this patient does have biases, being a retrospective study, but there are important medical legal implications for this kind of study. It does show the safety of outpatient osteotomy surgery, and it's also helpful for patients to be counseled preoperatively about the fact that this can be done as an outpatient rather than having to stay in the hospital, as well as the potential cost savings that can come with doing these procedures in outpatient instead of as an inpatient. So with that, I thank you all for your attention.

NYU

knee osteotomies

ambulatory surgery center

inpatient hospital facility

complication profiles