Presentation Authors: Patrick Hensley*, Jeffrey Goodwin, Adam Dugan, Mauro Hanaoka, Jason Bylund, Adrew Harris, Lexington, KY
Introduction: Extended PACU length of stay (PLOS) can frustrate patients and physicians, delay postoperative care pathways, and potentially increase cost. Predictors of increased PLOS are unknown. We examined patient-specific factors and cost in relation to PLOS.
Methods: The NSQIP (National Surgery Quality Improvement Program) database was queried for our institution to identify patients treated with open 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.
Results: 787 cases were included. Median PLOS (MPLOS) was 5.0 hours (IQR 3.0-8.0, Table 1). Overnight PLOS (OPLOS) occurred in 132 pts (17.7%). Among preoperative variables, PLOS was longer in patients with preoperative dyspnea (p < 0.01), creatinine >1.3, (p < 0.01) or BUN >21, (p < 0.05). Higher ASA class was associated with longer MPLOS, (p < 0.01). MPLOS for patients undergoing RP and RC was slightly shorter than for renal cases (4 hrs vs 5 hrs, p < 0.05). Increased PLOS was not associated with postoperative complications. OPLOS was more expensive with a median total cost $16,800 vs $15,900 (p < 0.05), and had higher median total hospital charges, $58,300 vs $51,800 (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 higher in the OPLOS cohort compared to the non-OPLOS cohort, $9,000 vs $7,800 (p=0.015), and $1,200 vs $1,000 (p=0.02), respectively. There was no association between PLOS and overall hospital LOS (p=0.400).
Conclusions: ASA class, preoperative dyspnea, renal dysfunction, and surgery type were associated with increased PLOS. OPLOS significantly increases cost but is not associated with increased complication rate. Non-patient specific characteristics such as bed occupancy may come into play and should be further investigated to improve quality of care.