Laird Harrison

November 02, 2015

SAN DIEGO — With the perioperative surgical home model — in which an anesthesiologist manages a patient's surgical experience in collaboration with the patient, the patient's family, and other healthcare providers — hospital stays are shorter and rates of discharge home are higher, according to a new study.

The findings show that the program has a promising future beyond its initial implementation, said James Cyriac, MD, from the University of California, Irvine.

"We feel we have had a very significant sustainable impact on our total joint program," he said here at Anesthesiology 2015 from the American Society of Anesthesiologists (ASA).

In their study, Dr Cyriac and his colleagues analyzed the perioperative surgical home model, an ASA initiative designed to save money and improve quality by coordinating care.

The UC Irvine Medical Center was one of the first institutions to implement the model. In its first year, national standards for length of stay, complications, blood transfusions, and surgical care improvement project compliance were met or exceeded.

But many such initiatives lose their impact after the initial enthusiasm wanes, said Dr Cyriac, so at UC Irvine, program leaders refined the model in the second year.

The very big thing we were excited about was the number of patients who went home.

To see whether the efforts paid off, the investigators reviewed data from 328 patients who underwent elective knee or hip replacement as part of the perioperative surgical home program from October 2012 to September 2014.

During the 2-year period, there was no significant change in average age, ASA physical status, comorbidities, and payer mix for the patients. However, there was an increase in the use of spinal anesthesia, a slight increase in body mass index, and a decrease in the use of general anesthesia.

For hip replacement patients, median hospital stay was 28% lower in the second year than in the first year (= .02). For knee replacement patients, however, there was no difference in length of stay between the first and second years.

The percentage of hip replacement patients going home, rather than to a skilled nursing facility, was nearly twice as high in the second year as in the first year (32.9% vs 17.6%; = .02).

"We did have a lower length of stay, which was statistically significant. But I would be the first to say that, clinically, I don't think it meant very much," said Dr Cyriac. "The very big thing we were excited about was the number of patients who went home."

Readmission rates in the 30 days after surgery were higher in the second year than in the first year, but the difference was not significant (3.3% vs 0.9%).

There was no significant difference in median Numerical Rating Scale for Pain between the second and first years.

After the presentation, a member of the audience asked how the approach used at UC Irvine could be transferred to other institutions.

The key is to solicit involvement from all concerned parties before trying to implement any changes, Dr Cyriac said. "If you bring everyone in at the beginning and you start the conversation with all these stakeholders, you get the buy-in."

Dr Cyriac's presentation and others in the session are encouraging, said Shubjeet Kaur, MD, from the University of Massachusetts Medical School in Worcester.

"That shows it's taking root a little bit," she told Medscape Medical News.

Dr Cyriac and Dr Kaur have disclosed no relevant financial relationships.

Anesthesiology 2015 from the American Society of Anesthesiologists (ASA): Abstract A1031. Presented October 24, 2015.


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