Optimizing Value of Colon Surgery in Michigan

Area of Science:

• Surgical Quality Improvement
• Health Services Research
• Cost-Effectiveness Analysis

Background:

• Surgical site infections (SSI) following colectomy increase patient morbidity and healthcare expenses.
• Perioperative care bundles are designed to standardize and enhance the processes surrounding colectomy.
• Previous research indicates a need to evaluate the comprehensive value of such bundled interventions.

Purpose of the Study:

• To assess the impact and value of implementing bundled perioperative care measures in colon surgery.
• To determine the association between compliance with care bundles and surgical site infection rates.
• To evaluate the economic implications, including episodic costs, of perioperative care bundling.

Main Methods:

• A retrospective cohort study utilizing data from the Michigan Surgical Quality Collaborative (MSQC) database.
• Inclusion of 3,387 patients who underwent elective colon surgery between 2012 and 2015.
• Analysis of 332 cases with associated episodic cost data to correlate care bundle compliance with outcomes and costs.

Main Results:

• High compliance (3-6 elements) with perioperative care bundles was associated with significantly lower risk-adjusted SSI rates (8.2%) compared to low compliance (16.0%).
• The high compliance group experienced absolute risk reductions in superficial, deep, and organ space SSIs.
• High compliance led to a substantial reduction in average episodic costs ($4,774, 23.8%), with decreased facility, professional, and other payments.

Conclusions:

• Perioperative care bundling in Michigan is linked to improved value in surgical care for colon surgery patients.
• Implementation of perioperative care bundles demonstrates a strategy to enhance patient outcomes and reduce healthcare expenditures.
• Expansion of perioperative care bundle implementation is recommended to further optimize surgical care quality and cost-effectiveness.