Professor of Clinical Anesthesiology, Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USA.
Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA, USA.
J Clin Anesth. 2024 Nov;98:111596. doi: 10.1016/j.jclinane.2024.111596. Epub 2024 Sep 2.
When the vast majority (e.g., ≈90%) of a specialty's elective (scheduled) care is ambulatory (i.e., length of stay 0 or 1 night), the administrative, clinical, and economic policy implications are profound. We examined the progressive shift of elective anesthetics in Florida from inpatient to ambulatory, from the first quarter of 2010 through the fourth quarter of 2022. We were particularly interested in the most recent data following the lifting of COVID-19 restrictions on elective surgery in the state.
This retrospective cohort study included major therapeutic and major diagnostic procedures with >0 American Society of Anesthesiologists base units in the state of Florida inpatient and ambulatory surgery databases. The last 8 quarters of these operating room anesthetic data corresponded to the end of restrictions on elective surgery in Florida due to the COVID-19 pandemic. Our goal was to determine whether the overall mean percentage of cases with 0- or 1-day lengths of stay has reached 90% since the lifting of pandemic restrictions. Numbers of cases over periods of at least four weeks tend to follow normal distributions. Therefore, we analyzed the N = 8 quarters of cases from 2021 to 2022 using Student's t-test. The study was performed when there were N = 8 quarters available from the Florida healthcare databases.
There were overall 22,584,752 surgical cases studied. The percentages of elective anesthetics with length of stay ≤1-day increased progressively from 2010 through 2020. Among the eight successive quarters since the end of pandemic-related elective surgery restrictions, the percentage of elective cases with length of stay 0- or 1 day was stable, averaging 90% (95% two-sided confidence interval 89.4% to 90.3%).
Since the COVID-19 pandemic, the mean quarterly percentage of elective surgery cases with anesthesia in Florida that were ambulatory has been reliably ≈90%. Implications include value in expecting overnight post-anesthesia care unit stay in ambulatory surgery centers and scheduling and sequencing cases based on post-anesthesia care unit capacity. Furthermore, because the vast majority (i.e., ≈90%) of cases would be excluded (i.e., not involve hospital admission for at least 2 midnights), there is a minimal role that risk-adjusted hospital length of stay and mortality can have in evaluating anesthesia department overall quality and economic effectiveness.
当一个专业的大部分（例如，约 90%）选择性（计划）护理是门诊（即住院时间为 0 或 1 晚）时，其管理、临床和经济政策意义是深远的。我们检查了佛罗里达州从 2010 年第一季度到 2022 年第四季度，选择性麻醉从住院到门诊的逐步转变。我们特别关注该州解除 COVID-19 对选择性手术限制后的最新数据。
这项回顾性队列研究包括佛罗里达州住院和门诊手术数据库中每个季度>0 个美国麻醉师协会基础单位的主要治疗和主要诊断程序。这些手术室麻醉数据的最后 8 个季度对应于佛罗里达州因 COVID-19 大流行而取消选择性手术限制的结束。我们的目标是确定自大流行限制解除以来，住院时间为 0-1 天的病例总数百分比是否已达到 90%。至少四个星期的病例数往往遵循正态分布。因此，我们使用学生 t 检验分析了 2021 年至 2022 年的 8 个季度的病例数。当佛罗里达州医疗保健数据库中有 8 个季度的数据时，我们进行了这项研究。
共研究了 22584752 例手术病例。住院时间≤1 天的选择性麻醉百分比从 2010 年到 2020 年逐渐增加。自与 COVID-19 相关的选择性手术限制结束以来的连续八个季度中，住院时间为 0-1 天的选择性病例百分比保持稳定，平均为 90%（95%双侧置信区间 89.4%至 90.3%）。
自 COVID-19 大流行以来，佛罗里达州选择性手术病例中接受麻醉的门诊手术比例平均约为 90%。这意味着在期望在门诊手术中心进行术后麻醉护理单元停留，并根据术后麻醉护理单元的容量安排和安排病例方面具有价值。此外，由于绝大多数（即，约 90%）的病例将被排除（即，至少 2 个午夜不涉及住院治疗），因此风险调整后的住院时间和死亡率在评估麻醉部门的整体质量和经济效果方面的作用微乎其微。
