Acute hospital-community hospital care bundle for elderly orthopedic surgery patients: A propensity score-matched economic analysis

Table 1 Comparison of patient demographics, clinical characteristics, and hospitalization metrics between elderly patients who underwent elective orthopedic surgery before and after the care bundle intervention

Variable	Before care bundle period (2017-2018)	After care bundle period (2019-2021)	P value
	n (%)	n (%)
Matched patients	431	431
Age (yr), median (range)	79 (75-97)	80 (75-99)	0.184
Gender
Male	111 (25.8)	123 (28.5)	0.400
Female	320 (74.2)	308 (71.5)
ASA classification
1	3 (0.7)	8 (1.9)	0.074
2	336 (78.0)	311 (72.2)
3	92 (21.3)	112 (26.0)
4	0	0
CCI
0	3 (0.7)	8 (1.9)	0.200
1	12 (2.8)	21 (4.9)
2	316 (73.3)	292 (67.7)
3	16 (3.7)	18 (4.2)
≥ 4	84 (19.5)	92 (21.3)
Surgical approach
Open	346 (80.3)	337 (78.2)	0.502
MIS	85 (19.7)	94 (21.8)
AH LOS (d)
Median (range)	9 (7-73)	7 (1-44)	< 0.001
Mean (SD)	12.5 (13.8)	8.83 (7.02)	< 0.001
Discharged home	431 (100)	431 (100)	-
Postoperative mortality	0	0	-

Continuous variables were presented as median (range) or mean ± SD; categorical variables were presented as n (%). ASA: American Society of Anesthesiologists classification; CCI: Charlson Comorbidity Index; MIS: Minimally Invasive Surgery; AH: Acute hospital; LOS: Length of stay.

Table 2 Comparison of inpatient hospitalization costs between elderly patients receiving elective orthopedic surgery before and after the care bundle intervention

AH hospitalization cost (S$)	Before care bundle period (n = 431)	After care bundle period (n = 431)	% Difference	P value
Total inpatient cost per case	28772.8 (28581.6)	24497.3 (15281.8)	14.9% decrease	< 0.001
Cost breakdown
Surgery procedure	4861.8 (2076.2)	4594.6 (1847.1)	5.5% decrease	0.561
Ward accommodation	8748.8 (15164.3)	5924.4 (6277.9)	32.3% decrease	< 0.001
Daily medical treatment	3980.9 (4875.8)	2932.4 (2371.8)	26.3% decrease	< 0.001
Nursing	1574.3 (1715.5)	1379.9 (959.5)	12.4% decrease	0.040
Investigation	2173.2 (2086.3)	1847.1 (1828.1)	15.0% decrease	0.003
Rehabilitation	905.0 (1474.5)	634.0 (490.7)	29.9% decrease	< 0.001
Pharmacy	479.6 (1149.3)	414.8 (988.2)	13.5% decrease	0.369
Consumables	2231.4 (1883.8)	2412.2 (1631.4)	8.1% increase	0.132

Cost data were presented as mean ± SD in 2021 Singapore dollars (S$), adjusted for inflation. 1 Singapore dollar (S$) = 0.722 United States dollar (US$).

Table 3 Community hospitalization metrics in elderly patients undergoing elective orthopedic surgery within the care bundle intervention

Item	2019	2020	2021
Total case	135	170	126
CH LOS (d) (median, range)	23 (4-98)	24 (2-175)	22 (2-87)
Total AH-CH LOS (d) (median, range)	35 (8-122)	33 (5-184)	33 (9-114)
Referral time from AH to CH (d) (median, range)	4 (1-20)	5 (1-14)	3 (1-12)
U-turn from CH to AH within 8 h (%)	0	0	1 (0.79)
MBI score (median, range)
Admission	58 (11-98)	47 (5-94)	37 (10-97)
Discharge	74 (14-100)	65 (12-100)	68 (13-99)

Continuous variables were presented as median (range); categorical variables were presented as n (%). CH: Community hospital; LOS: Length of stay; AH: Acute hospital; MBI: Modified Barthel Index.