Open AccessEffect of Time to Operation on Value of Care in Acute Care Surgery
Author(s) -
Loftus Tyler J.,
Rosenthal Martin D.,
Croft Chasen A.,
Stephen Smith R.,
Efron Philip A.,
Moore Frederick A.,
Mohr Alicia M.,
Brakenridge Scott C.
Publication year - 2018
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-018-4476-2
Subject(s) - medicine , abdominal surgery , intensive care unit , cardiac surgery , laparotomy , cardiothoracic surgery , vascular surgery , sepsis , retrospective cohort study , reimbursement , surgery , hernia , emergency medicine , health care , economics , economic growth
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.