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Outpatient parotidectomy at the Fallon Clinic. The first 2 years
S H Bentkover1, B A Kozlicak, S Girouard
1Department of Surgery, Fallon Medical Center, Worcester, Mass, USA.
Objectives:
To determine whether outpatient parotidectomy can be performed safely with high patient satisfaction and to compare the cost of outpatient and inpatient parotidectomy.
Design:
A retrospective review of hospital and office charts of patients admitted for elective outpatient and inpatient parotidectomy from 1992 to 1994.
Setting:
A community teaching hospital and a multispecialty group practice that are part of an integrated health care system.
Patients:
Nineteen consecutive outpatients and 13 concurrent inpatients admitted electively for parotidectomy.
Intervention:
Outpatient and inpatient parotidectomies performed as a sole procedure.
Main Outcome Measures:
Duration of surgery and anesthesia, length of stay after surgery, complications, hospital and office charges, and a patient satisfaction survey.
Results:
Twenty patients were admitted for outpatient parotidectomy; 19 (95%) went home the same day. Outpatients were discharged an average of 4 hours after surgery. No complications were specifically attributable to outpatient status. The mean savings on hospital-based charges compared with a 1-night stay was $196 per case. The outpatients had 2 more postoperative visits in the first 90 days after surgery; their postoperative care cost $72 per case more than for the inpatient group. Patient satisfaction was high, but it was higher in the inpatient group.
Conclusions:
Parotidectomy can be performed safely on outpatients. Outpatient satisfaction was high, but inpatient satisfaction was higher. The savings per case depends on the particular cost structure of the institution and may be modest compared with that of a 1-night inpatient stay. Savings are higher when compared with the diagnosis-related group allowable stay of 4.0 days.