Ur Becca, Craven Timothy E, Hirsch Joshua, Corriere Matthew A, Edwards Matthew S, Hurie Justin B
Department of Surgery, Section of Vascular Surgery, University of Washington, Seattle, WA.
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
Ann Vasc Surg. 2019 Nov;61:100-106. doi: 10.1016/j.avsg.2019.04.034. Epub 2019 Jul 26.
The contemporary healthcare environment is complex with mounting pressures to perform greater procedural volumes with less support staff to minimize costs and maximize efficiency. This report details an analysis of routine endovascular procedures performed with dedicated vascular support staff during daytime hours compared to similar cases performed after hours with general operating room staff.
All lower extremity endovascular cases over a 37-month period were identified using Current Procedural Terminology codes from a query of our institutional database. Emergent/urgent cases and cases with associated open surgical procedures were excluded. Cases were divided according to the time of day and available clinical support structure according to procedure start time: specialty-specific daytime (SS) and general staff after hours for all others (AH). The resulting case list was examined by case type according to SS or AH designation and case types occurring disproportionately during either time frame were excluded to create a homogenous group of cases. Demographics, case specifics, and cost data were then obtained from the electronic health record and our enterprise cost data warehouse. Multivariable mixed linear modeling was used to examine component costs (i.e., anesthesia, supplies, etc.) and total costs controlling for a number of factors that could affect cost.
Two hundred fifty-two routine endovascular-only procedures were examined in 232 patients (190 SS, 42 AH). No significant differences in procedure specifics were observed between the groups [number and location of access site(s), indication for procedure, type and number of interventions, etc.]. Multivariable analyses controlled for factors affecting costs. Costs associated with anesthesia (cost ratio 1.90, P = 0.001), operating room time costs (cost ratio 1.29, P = 0.03), and post anesthesia recovery (cost ratio 1.23, P = 0.004) were all significantly increased in AH cases compared to SS cases. The average total hospital cost for routine endovascular cases that performed AH was $8,095 compared to $5,636 for SS cases (cost ratio 1.44, P = 0.008).
Performance of routine endovascular cases was associated with significantly less cost to the hospital system when performed by SS teams during regular hospital hours with a ∼30% increase in total cost associated with AH cases. In the current healthcare environment, investments in SS teams and process improvements are likely to be cost effective.
当代医疗环境复杂，面临着在支持人员减少的情况下完成更多手术量的压力，以尽量降低成本并提高效率。本报告详细分析了在白天由专门的血管支持人员进行的常规血管内手术，与下班后由普通手术室人员进行的类似手术相比的情况。
使用当前手术操作术语代码，通过查询我们机构的数据库，确定了37个月期间所有下肢血管内手术病例。排除急诊/紧急病例以及相关开放手术病例。根据手术开始时间，将病例按白天时间和可用临床支持结构进行划分：特定专科白天手术（SS），其他所有病例在下班后由普通人员进行（AH）。根据SS或AH指定，按病例类型检查所得病例列表，并排除在任何一个时间段中出现比例失调的病例类型，以创建一组同质病例。然后从电子健康记录和我们的企业成本数据仓库中获取人口统计学、病例详情和成本数据。使用多变量混合线性模型来检查组成成本（即麻醉、耗材等）以及控制可能影响成本的多个因素后的总成本。
对232例患者进行了252例仅常规血管内手术（190例SS，42例AH）。两组之间在手术细节方面未观察到显著差异[穿刺部位的数量和位置、手术指征、干预类型和数量等]。多变量分析控制了影响成本的因素。与SS病例相比，AH病例中与麻醉相关的成本（成本比率1.90，P = 0.001）、手术室时间成本（成本比率1.29，P = 0.03）和麻醉后恢复成本（成本比率1.23，P = 0.004）均显著增加。AH常规血管内病例的平均总住院成本为8,095美元，而SS病例为5,636美元（成本比率1.44，P = 0.008）。
由SS团队在医院正常工作时间进行常规血管内手术时，医院系统的成本显著降低，而AH病例的总成本增加约30%。在当前医疗环境下，对SS团队的投资和流程改进可能具有成本效益。
