Category: Epidemiology, Health Policy, Socioeconomics & Outcomes
Introduction & Objective :
Extended PACU length of stay (PLOS) can be frustrating for patients and physicians, delay postoperative care pathways, and potentially increase cost. Predictors of increased PLOS are unknown. We examine patient-specific factors and cost in relation to PLOS.
Methods : We used NSQIP (National Surgery Quality Improvement Program) data for our institution and retrospectively identified patients treated with radical cystectomy (RC), robotic prostatectomy (RP), laparoscopic nephrectomy (LN), and minimally invasive partial nephrectomy (MIS PN) by CPT code. Perioperative data, PLOS, and finance data were analyzed.
Seven-hundred and eighty-seven cases were identified and analyzed. Median PLOS (MPLOS) was 5.0 hours (IQR 3.0-8.0), overnight PLOS (OPLOS) was seen in 132 pts (17.7%). OPLOS was associated with significantly longer overall PLOS, 17 hours vs 3.5 hours (p<0.001). Among preoperative variables, PLOS was longer in patients with preoperative dyspnea, creatinine >1.3 mg/dl,and BUN >21 mg/dl. (p<0.05). MPLOS for patients undergoing RP and RC was slightly shorter than renal cases (4 hrs vs 5 hrs, p<0.05). Higher ASA class was associated with longer MPLOS, (p<0.01). Increased PLOS was not associated with any postoperative complications. OPLOS was associated with ASA class, bleeding disorder, and BUN>21 (p<0.05).
When comparing patients staying overnight in the PACU to those not staying overnght, OPLOS was more expensive with a median total cost $16,800 (IQR $13,800-$18,800) vs $15,900 (IQR $12,900-$18,500; p<0.05) , and had higher median total hospital charges, $58,300 (IQR $42,000 - $66,000) vs $51,800 (IQR $40,000 - $62,600; p=0.004). OPLOS carried more direct ($11,200 vs $10,500; p=0.049) and indirect costs, ($5,400 vs $5,100; p=0.016). Operating Room and floor direct costs were different between the OPLOS cohort and the non-OPLOS cohort., $9,000 vs $7,800, p=0.015, and $1,000 vs $1,200, p=0.02. There was no association between PLOS and overall hospital LOS. Table 1
ASA class, preoperative dyspnea, renal dysfunction, and surgery type were associated with PLOS. However, few patient-specific characteristics contritbute to OPLOS and non patient-specific characteristics, such as bed occupancy and flow, may come into play as well. OPLOS is significantly more expensive and further study into non-patient causes is needed.
Andrew Harris– Endourology/Robotics Fellow, University of Kentucky, Lexington, Kentucky
Jeff Goodwin– Lexington, Kentucky
Patrick Hensley– Lexington, Kentucky
Mauro Hanaoka– Lexington, Kentucky
Jason Bylund– Associate Professor, University of Kentucky, Lexington, Kentucky
University of Kentucky
My name is Andrew M. Harris, MD and I'm currently the endourology and robotics fellow at the University of Kentucky. I finished my residency training at the University of Pennsylvania in 2012 followed by a brief period in private practice prior to matriculation to fellowship. My reserach efforts focus on health care economics/cost/safety/qi/lean implementation/resident education and am currently in classes to receive a certificate in improving health care value with an emphasis in safety and quality improvement.