Process improvements reduce utilization of resources for aortic aneurysm repair

Area of Science:

• Vascular Surgery
• Health Services Research
• Healthcare Management

Background:

• Ambulatory surgery (AS) programs were implemented within the VA system to enhance healthcare efficiency.
• These programs involve outpatient preoperative assessment and operative management.
• The study investigates the impact of AS on resource utilization for abdominal aortic aneurysm (AAA) repair.

Purpose of the Study:

• To evaluate the effect of ambulatory surgery program implementation on resource utilization for patients undergoing elective infrarenal AAA repair.
• To compare preoperative testing, ICU days, and inpatient length of stay (LOS) before and after AS program implementation.
• To assess postoperative morbidity and mortality in relation to the AS program.

Main Methods:

• Retrospective review of medical records for 15 patients undergoing AAA repair before (1992-1993) and after (1995-1996) AS implementation.
• Analysis of preoperative tests (inpatient vs. outpatient), ICU days, inpatient LOS, morbidity, and mortality.
• Statistical comparison between the pre-AS and post-AS groups, noting similar patient demographics and comorbidities.

Main Results:

• Outpatient performance of abdominal ultrasound, CT scanning, and angiography significantly increased post-AS implementation.
• Median preoperative LOS decreased from 6 days to 1 day (P = 0.001).
• Inpatient LOS was significantly reduced (16 days vs. 11 days, P < 0.01), with similar survival and complication rates.

Conclusions:

• Ambulatory surgery programs can significantly decrease hospital resource utilization for major procedures like AAA repair.
• Shifting preoperative assessment to the outpatient setting is a key factor in reducing overall length of hospitalization.
• The benefits of AS programs extend beyond outpatient surgeries, improving efficiency for inpatient procedures as well.