Inpatient versus Outpatient Alveolar Bone Grafting: A Nationwide Cost Analysis

Objective To compare postoperative outcomes and costs between inpatient and outpatient ABG in the United States. Design Retrospective cohort. Setting Multi-institutional/national. Patients and Participants Patients who underwent ABG (n = 6649) were identified in the National Surgical Quality Improvement Program Pediatric database from 2012–2021. Inpatient and outpatient cohorts were matched using coarsened exact matching. Main outcomes measure (s) Thirty-day readmission, reoperation, and complications. A modified Markov model was developed to estimate the cost difference between cohorts. One-way and probabilistic sensitivity analyses were performed. Results After matching, 3718 patients were included, of which 1859 patients were in each hospital-setting cohort. The inpatient cohort had significantly higher rates of reoperations (0. 6% vs. 0. 2%; p = 0. 032) and surgical site infections (0. 8% vs. 0. 2%; p = 0. 018). The total cost of outpatient ABG was estimated to be 10, 824 vs. 20, 955 for inpatient ABG, resulting in 10, 131 cost savings per patient. Probabilistic sensitivity analysis revealed that all 10, 000 simulations resulted in consistent cost savings for the outpatient cohort that ranged from 8000 to 24, 000. Conclusions Outpatient ABG has become increasingly more popular over the past ten years, with a majority of cases being performed in the ambulatory setting. If deemed safe for the individual patient, outpatient ABG may confer a lower risk of nosocomial complications and offer significant cost savings to the healthcare economy.