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Erschienen in: World Journal of Surgery 8/2018

19.01.2018 | Original Scientific Report

Effect of Time to Operation on Value of Care in Acute Care Surgery

verfasst von: Tyler J. Loftus, Martin D. Rosenthal, Chasen A. Croft, R. Stephen Smith, Philip A. Efron, Frederick A. Moore, Alicia M. Mohr, Scott C. Brakenridge

Erschienen in: World Journal of Surgery | Ausgabe 8/2018

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Abstract

Background

As reimbursement models evolve, there is increasing emphasis on maximizing value-based care for inpatient conditions. We hypothesized that longer intervals between admission and surgery would be associated with worse outcomes and increased costs for acute care surgery patients, and that these associations would be strongest among patients with high-risk conditions.

Methods

We performed a 5-year retrospective analysis of three risk cohorts: appendectomy (low-risk for morbidity and mortality, n = 618), urgent hernia repair (intermediate-risk, n = 80), and laparotomy for intra-abdominal sepsis with temporary abdominal closure (sTAC; high-risk, n = 102). Associations between the interval from admission to surgery and outcomes including infectious complications, mortality, length of stay, and hospital charges were assessed by regression modeling.

Results

Median intervals between admission and surgery for appendectomy, hernia repair, and sTAC were 9.3, 13.5, and 8.1 h, respectively, and did not significantly impact infectious complications or mortality. For appendectomy, each 1 h increase from admission to surgery was associated with increased hospital LOS by 1.1 h (p = 0.002) and increased intensive care unit (ICU) LOS by 0.3 h (p = 0.011). For hernia repair, each 1 h increase from admission to surgery was associated with increased antibiotic duration by 1.6 h (p = 0.007), increased hospital LOS by 3.3 h (p = 0.002), increased ICU LOS by 1.5 h (p = 0.001), and increased hospital charges by $1918 (p < 0.001). For sTAC, each 1 h increase from admission to surgery was associated with increased antibiotic duration by 5.0 h (p = 0.006), increased hospital LOS by 3.9 h (p = 0.046), increased ICU LOS by 3.5 h (p = 0.040), and increased hospital charges by $3919 (p = 0.002).

Conclusions

Longer intervals from admission to surgery were associated with prolonged antibiotic administration, longer hospital and ICU length of stay, and increased hospital charges, with strongest effects among high-risk patients. To improve value of care for acute care surgery patients, operations should proceed as soon as resuscitation is complete.
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Metadaten
Titel
Effect of Time to Operation on Value of Care in Acute Care Surgery
verfasst von
Tyler J. Loftus
Martin D. Rosenthal
Chasen A. Croft
R. Stephen Smith
Philip A. Efron
Frederick A. Moore
Alicia M. Mohr
Scott C. Brakenridge
Publikationsdatum
19.01.2018
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 8/2018
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4476-2

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