Abstract
BackgroundHospital length of stay (LOS) remains an important, albeit nonspecific, metric in the analysis of surgical services. Modifiable factors to reduce LOS are few in number and the ability to practically take action is limited. Surgical scheduling of elective cases remains an important task in optimizing workflow and may impact the post-surgical LOS.MethodsRetrospective data from a single tertiary care academic institution were analyzed from elective adult surgical cases performed from 2017 through 2019. Emergent or urgent add-on cases were excluded. Variables included primary procedure, age, diabetes status, American Society of Anesthesiologists (ASA) class, and surgical start time. Analysis of the median LOS following surgery was performed using Mann-Whitney tests and Cox hazards model. Matched-cohort analysis of mean total hospitalization costs was performed using the Student’s t-test. Results9,258 patients were analyzed across five surgical service lines, of which 777 patients had surgical start time after 3 PM. The median LOS for the after 3 PM group was 1 day longer than the before 3 PM start time cohort (3.0 vs 2.1, p < 0.001). Service line analysis revealed increased LOS for Orthopedics and Neurosurgery (3.0 vs 1.9, p < 0.001; 3.0 vs 2.0, p < 0.05). Multivariate analysis confirmed that start time before 3 PM predicted shorter LOS (HR = 1.214, 1.126-1.309; p < 0.001). Case-matched cost analysis for frequently performed orthopedic and neurosurgical cases with an after 3 PM start time failed to demonstrate a significant difference in total hospital charges. ConclusionOptimization of surgical services scheduling to increase the proportion of elective surgical cases started before 3 PM has the potential to decrease post-surgical LOS for adult patients undergoing Orthopedic or Neurosurgical procedures.
Highlights
The operational efficiency of elective surgical procedures with planned hospital admissions is dependent on multitude of factors, only a small portion of which are modifiable
Hazard ratios (HR) demonstrated significance for shorter post-surgical length of stay based on age
The impact of elective surgical procedures on overall operating costs for US hospitals was highlighted by the Healthcare Cost and Utilization Project published through the Agency for Healthcare Research and Quality (AHRQ) where only 29% of hospitalizations involved a surgical procedure, but these hospitalizations accounted for 48% of the $387 billion in hospital costs in 2011 [6]
Summary
The operational efficiency of elective surgical procedures with planned hospital admissions is dependent on multitude of factors, only a small portion of which are modifiable. Comorbid states, surgical experience of the operative staff, and the underlying diagnosis are all areas in which the patients and providers have limited control. Parameters such as the choice of peri-operative medications, post-operative mobilization plans and surgical start time are slightly more adaptable and offer the potential opportunity for optimization. Hospital length of stay (LOS) remains one of the most studied endpoints in outcomes research as it relates to efficiency in care delivery.
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