Practical cost-effective choices: ambulatory general anesthesia

To determine cost-effectiveness, we need to determine the value obtained for the price paid. Several points emerge. We need to identify specific recovery goals as our benefits, looking at early, intermediate, and late phases of recovery. Benefits such as effects on nausea may be specific to the procedure, duration, and site of practice. Time savings in the OR or recovery areas do not generate cost savings unless utilization actually increases or staffing actually decreases. Recovery care protocols that mandate a specific duration of stay in the PACU can negate any intraoperative or postoperative benefit differences generated by an anesthetic agent. Most of all, it is difficult to assign a dollar value to a very important benefit: patient satisfaction. Each of us, in our practices, must identify cost-effective choices for ambulatory anesthesia. Determining prices is simple. This we can and should do. Determining value, however, is more complicated and it is in this direction our work must lie.