Outpatient Management of Slipped Capital Femoral Epiphysis Is Common, Safe, and Saves Costs: A Single-Institution Analysis and Results From a National Database Survey.

Abstract

Slipped capital femoral epiphysis (SCFE) is a condition requiring surgical fixation on a semiurgent basis. Although recent studies have evaluated the safety of outpatient SCFE management, none have examined cost in this population. Furthermore, it is unclear what percent of in situ SCFE fixation is done on an outpatient basis nationally. A retrospective chart review of patients treated between the years 2015 to 2024 was conducted at a large tertiary-care children's health system. Patients undergoing in situ fixation for stable SCFE and a minimum 90 days follow-up were included. Demographics, outcomes, and charges were compared between patients treated as outpatients or inpatients. A review of the national PearlDiver database was performed to determine frequency of inpatient versus outpatient settings for this procedure. A total of 95 patients with stable SCFE were included. The mean age was 11.6 ± 1.9 years. Thirty patients were admitted through the emergency department, 19 of which underwent admission, surgery, and discharge on the same day. In total, 65 patients were scheduled as outpatients from clinic, 58 of which were true outpatient procedures. There was no difference in 90-day complications between groups. There was, however, a significant difference in patient charges for scheduled outpatients versus ED admissions ($10,052.40 vs $13,285.14; P = 0.001). In addition, scheduled outpatient surgery was less expensive than treatment through the ED, even if fixation and discharge occurred the same day ($9,669.90 vs $11,585.78; P = 0.041). On a national level, outpatient SCFE management is more frequent than inpatient management ( P = 0.0016). This study suggests that stable SCFE can safely be an outpatient procedure with significant cost savings. A national trend toward outpatient SCFE management is evident, mirroring general healthcare trends.